Three-year survey of community-acquired methicillin-resistant Staphylococcus aureus producing Panton-Valentine leukocidin in a French university hospital

A retrospective survey was conducted at Bicêtre Hospital, France from January 2001 to September 2003 to screen for S. aureus isolates with a typical phenotype previously involved in necrotizing pneumonia in France. They were resistant to oxacillin and kanamycin, of intermediate susceptibility to fusidic acid, and susceptible to tobramycin and fluoroquinolones. Seventeen isolates were found and 16 were viable. The Panton-Valentine leukocidin (PVL) genes, various toxin genes and SCCmec IV and agr3 alleles were detected in all isolates. The clonal origin of these isolates was demonstrated by pulsed-field gel electrophoresis. Fourteen isolates were community-acquired methicillin-resistant Staphylococcus (CA-MRSA) isolated from previously healthy patients with skin or soft tissue infections. Three infections were of nosocomial origin, underlining that these PVL-producing CA-MRSA strains may also be hospital acquired. Five CA-MRSA isolates with an identical resistance phenotype collected in a neighbouring teaching hospital (H?pital Pitié-Salpétrière, Paris, France) were also PVL positive. Three isolates were clonally related to those of the Bicêtre Hospital whereas two were not. This retrospective study identified PVL-producing CA-MRSA in two Parisian hospitals. The incidence at Bicêtre Hospital was 0.8% of all S. aureus and 2% of all MRSA isolated. Our data indicate that these MRSA isolates might become hospital acquired.     

Epidemiology and antimicrobial resistance of Streptococcus pneumoniae strains isolated in Ile de France area during 2001

OBJECTIVE: The authors wanted to assess the level of Streptococcus pneumoniae antibiotic resistance in Ile de France. METHOD: In 2001, 637 clinical strains of S. pneumoniae were prospectively collected from 32 microbiology laboratories. RESULTS: Fifty one percent of strains were isolated from children under 15 years of age and 49% from adults. In children, 76% of strains came from otitis media, 20% from blood culture, in adults most strains (92%) came from blood culture. The overall prevalence of non-susceptible penicillin pneumococci was 61% higher in children (73%) than in adults (50%). Among the non-susceptible penicillin pneumococci 21.8% were resistant (CMI > 1 mg/l). Strains with decreased susceptibility to amoxicillin and cefotaxime were 38% and 17% respectively. Resistant strains to these two drugs (CMI > 2 mg/l) were rare 2.6% and 0.4% respectively. Among other antimicrobial agents, rate of resistance was 63% to erythromycin, 47% to cotrimoxazole, 40% to tetracycline, and 23% to chloramphenicol. The most frequent serogroups were serogroups 19 and 14, respectively 23% and 18%. Serotypes included in heptavalent vaccine covered 90% of children strains under 2 years of age. CONCLUSIONS: The prevalence of resistance to penicillin was high in children particularly in otitis media pus (76%).     

3年医院感染主要病原菌的耐药性及应对措施

目的 了解医院近3年来5种主要病原菌耐药性,为临床治疗细菌感染提供依据.方法 采用法国生物梅里埃公司ATB Expression鉴定仪进行细菌鉴定,用K-B纸片法进行药敏试验.结果 2007-2009年5种主要病原菌分离株数量均不断上升,3年大肠埃希菌由588株上升至690株、肺炎克雷伯菌由157株上升至271株、铜绿假单胞菌由195株上升至537株、鲍氏不动杆菌由36株上升至327株、金黄色葡萄球菌由374株上升至505株,5种菌对常用抗菌药物的耐药率多数＞50.0％.结论 医院常见病原菌耐药严重,临床医师应根据药敏结果合理选择抗菌药物,针对病原菌的特点,采取有效的应对措施.     

Activity of nalidixic acid and fluoroquinolones on Escherichia coli strains isolated from non-complicated urinary infections (reseau TSN - France, 1999 - 2001)

OBJECTIVE: The authors studied the susceptibility of 1,647 non-repeat isolates of Escherichia coli to quinolones and fluoroquinolones. METHOD: The strains were isolated from non-complicated urinary infections in women 18-64 years of age. Data was provided by the TSN Database France, a real time electronic database which collects antibiotic susceptibility results and patient demographic data. The data was collected from 1999 to 2001 in 63 French hospital laboratories, each using their own routine test methods. Quantitative data was interpreted (S, I, R) according to CA-SFM breakpoint guidelines. RESULTS: Ninety-eight and 94,6 % of the strains were susceptible to ciprofloxacin and nalidixic acid respectively. Cross resistance was assessed as well as intrinsic difference in activity within the fluoroquinolone class. Current fluoroquinolones are still highly efficient, and ciprofloxacin is the most active. CONCLUSION: Since 1996, little change in resistance to fluoroquinolones has been observed. These results confirm the choice of fluoroquinolones as first intention therapy as recommended by consensus conferences.     

2008-2009年革兰阳性球菌敏感性监测

目的 监测深圳地区革兰阳性球菌的耐药情况.方法 细菌鉴定和药敏试验采用MicroScan40/96全自动微生物鉴定仪,数据分析采用MicroScan Labpro 2.41软件进行统计分析.结果 2008- 2009年共检出革兰阳性球菌605株,其中葡萄球菌属466株,未检出耐万古霉素、利奈唑胺、喹奴普汀/达福普汀葡萄球菌;182株金黄色葡萄球菌中,耐甲氧西林金黄色葡萄球菌( MRSA)检出56株,检出率为30.8％,对磺胺甲噁唑/甲氧苄啶、氯霉素有较高的抗菌活性,敏感率分别为98.5％和81.5％;155株表皮葡萄球菌中,耐甲氧西林表皮葡萄球菌检出123株,检出率为79.4％,对利福平、氯霉素和克林霉素有较高的抗菌活性,敏感率分别为88.5％、80.5％、79.5％;74株溶血葡萄球菌中,耐甲氧西林溶血葡萄球菌检出70株,检出率为94.6％,对利福平和四环素有较高的抗菌活性,敏感率分别为94.5％和71.5％;47株人葡萄球菌中,耐甲氧西林人葡萄球菌检出30株,检出率为63.8％,对左氧氟沙星、环丙沙星和利福平有较高的抗菌活性,敏感率分别为91.0％、91.0％和88.5％;86株肠球菌属中未发现耐万古霉素肠球菌,粪肠球菌对青霉素、氨苄西林、利奈唑胺、喹奴普汀/达福普汀和万古霉素的敏感率均为100.0％.结论 甲氧西林敏感金黄色葡萄球菌(MSSA)和甲氧西林敏感凝固酶阴性葡萄球菌(MSCNS)对多数抗菌药物有较高的抗菌活性,MRSA和MRCNS呈多药耐药性,且凝固酶阴性葡萄球菌不同种对苯唑西林和多种抗菌药物的敏感率有较大差异;屎肠球菌亦呈多药耐药性.     

胆道感染患者的病原菌分布及耐药性分析

目的 了解胆道感染患者的病原菌分布及耐药性特点,指导合理用药.方法 送检标本275例,菌种分离培养和药物敏感试验执行《全国临床检验操作规程》(第3版)标准;分析仪器采用全自动微生物(VITEK-32法国)分析仪鉴定,用K-B法进行药物敏感试验,操作规程执行《全国临床检验操作规程》,结果判断执行美国临床实验室标准化研究所(CLSI)标准.结果 送检标本275份,检出病原菌183株,检出率为66.55％;其中革兰阴性菌95株,占51.91％,革兰阳性菌63株,占34.43％,真菌12株,占6.56％;大肠埃希菌、肺炎克雷伯菌对亚胺培南/西司他丁的耐药率为0,粪肠球菌、屎肠球菌、葡萄球菌属对喹诺酮类耐药率较低.结论 胆道系统感染的病原菌分布广泛且变化较大,有些菌株产生多药耐药性;建议临床医师重视监测病原菌菌群动态分布和药敏变化,用药敏结果指导临床合理用药,才能取得良好效果.     

肺炎链球菌对大环内酯类抗菌药物耐药机制的研究

目的 调查烟台地区肺炎链球菌对抗菌药物的敏感性,研究烟台地区肺炎链球菌对大环内酯类抗菌药物耐药机制.方法 收集社区和临床分离的肺炎链球菌.根据美国临床实验室标准化研究所/美国临床实验室标准化委员会(CLSI/NCCLs)的推荐,用K-B法、Etest法检测肺炎链球菌对青霉素等11种抗菌药物的耐药性及对大环内酯类抗菌药物的耐药表型;用聚合酶链反应(PCR)扩增耐药基因ermB和mefE基因.结果 42株肺炎链球菌中25株对青霉素低度耐药(65.0%),无对青霉素高度耐药株;肺炎链球菌对大环内酯类和克林霉索表现出极高的耐药率,对红霉素和克林霉素耐药率为98.0 %和93.0%;42株肺炎链球菌中40株检测到ermB基因、1株检测剑mefE基因,其中9株菌同时检测到ermB和mefE基因.结论 烟台地区对青霉素不敏感肺炎链球菌检出率高;对红霉素和克林霉素近乎全部耐药,ermB基因介导的靶位改变是烟台地区肺炎链球菌对大环内酯类抗菌药物的主要耐药机制.     

2008-2010年县级医院肠杆菌科细菌耐药性监测

目的 了解某县级医院临床分离的肠杆菌科细菌对常用抗菌药物的耐药性.方法 采用法国生物梅里埃公司API系统进行菌株鉴定;采用K-B法进行药物敏感试验.结果 2008年1月-2010年12月医院临床共分离455株肠杆菌科细菌,以大肠埃希菌为主,224株占49.2％,其次为克雷伯菌属87株占19.1％;肠杆菌科细菌除对亚胺培南敏感率为100.0％外,对其他大多数抗菌药物表现为高度耐药;产ESBLs大肠埃希菌和克雷伯菌属检出率分别为65.6％、54.0％.结论 某县级医院临床分离的肠杆菌科细菌对常用抗菌药物耐药率呈上升趋势,应加强监测与控制.     

小儿呼吸道感染金黄色葡萄球菌的耐药性分析

摘要:目的 调查金黄色葡萄球菌在小儿呼吸道标本中的检出情况及耐药特点,为临床治疗提供依据。方法 对小儿科2011-2014年4 876份呼吸道标本检出的金黄色葡萄球菌耐药性进行回顾性分析总结;采用法国生物梅里埃公司VITEK-2全自动微生物鉴定仪进行菌株鉴定,K-B法进行药敏试验,结果判断参照美国临床实验室标准化研究所标准;采用WHONET软件进行统计分析。结果 共检出448株金黄色葡萄球菌,其中检出耐甲氧西林金黄色葡萄球菌（MRSA）42株,占9.4%。耐药率较高的抗菌药物主要是青霉素G（92.9%）、红霉素（58.0%）、克林霉素（55.1%）、四环素（19.9%）等;MRSA的耐药情况较甲氧西林敏感的金黄色葡萄球菌（MSSA）明显严重,对庆大霉素、环丙沙星、左旋氧氟沙星、莫西沙星、红霉素、克林霉素等耐药性差异有统计学意义（P＜0.05）。结论 小儿呼吸道标本检出的金黄色葡萄球菌以MSSA为主,对大部分的抗菌药物保持较好的敏感性,但其耐药性有上升趋势不容轻视。     

L'évolution de la résistance aux antibiotiques des bactéries impliquées dans les pneumonies aiguës communautaires

Micro-organisms such as Haemophilus influenzae and, above all, Streptococcus pneumoniae are often responsible for antibiotic resistance in acute community-acquired pneumopathies. Current resistance of H. influenzae to β-lactams is estimated at 35% of the strains and is steadily increasing. Its mechanisms are due to the production of β-lactamases, mainly TEM-1. Thus, the gold-standard treatment includes either a combination of amoxicillin with a β-lactamase inhibitor or an oral cephalosporin resistant to these enzymes. An other mechanism of resistance to β-lactams is due to the alteration of penicillin binding proteins (PBP) but its incidence is low (1–3%). Acquired resistance to other antimicrobial agents is still low, except for cotrimoxazole. In France, since 1987, S. pneumoniae has shown a dramatic increase of resistance to penicillin, resulting from two distinct mechanisms: clonal spreading of resistant strains and horizontal transfer of genes coding for altered PBP. In France, the current prevalence of penicillin-resistant S. pneumoniae (PRSP) is estimated at 48% of the strains, 58.5% of which exhibit MIC > 1 mg/L. For oral β-lactamins, amoxicillin has the lowest MICs against these resistant strains. For parenteral cephalosporins, cefotaxime, ceftriaxone, and imipenem are the most potent, and resistance to these antibiotics is rare in France. Most PRSP strains (75%) currently show multiresistance to other antibiotics, particularly to macrolides and cyclins. However, resistance to penicillin does not give therapeutic failures in clinical practice, since plasmatic concentrations largely exceed MICs of resistant germs. Therefore, penicillin G or amoxicillin are still promoted as first line therapies.     

医院感染常见病原菌耐药性变迁及对策

目的了解临床常见病原菌耐药性变化趋势,提出应对策略. 方法提取我院2000年1月～2003年12月4年中,自住院患者标本中分离数量占前4位的主要致病菌耐药性资料,采用API生化鉴定系统进行鉴定,并严格按美国临床试验室标准化委员会(NCCLS)制定标准用Kirby-Bauer法进行药物敏感性实验. 结果 4年中分离数量占前4位的表皮葡萄球菌、大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌1 290 株;耐药性分析显示:4种临床常见致病菌耐药率均呈逐年上升趋势,表皮葡萄球菌对16种抗菌药物中的9种耐药率均>70.5%,对万古霉素的耐药率最低(3.1%),其次为呋喃妥因(21.5%);大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌对18种抗菌药物中的10种耐药率>40%,仅对亚胺培南、头孢他啶的耐药率<22.0%,主要病原菌对部分抗菌药物产生多重耐药. 结论继续加强细菌耐药性监测,采取有效的应对措施,延缓耐药菌的产生和蔓延.     

常见非发酵革兰阴性杆菌的体外抗菌活性分析

目的　调查常用抗生素对临床常见非发酵革兰阴性杆菌的体外抗菌活性 ,为临床用药提供参考。方法　分析 2 0 0 1年 1月～ 2 0 0 2年 12月本院临床标本中分离出的铜绿假单胞菌、鲍氏不动杆菌和嗜麦芽寡养单胞菌对常用抗生素的耐药性 ,细菌鉴定及药敏试验采用VITEK 6 0全自动微生物鉴定仪。结果　检出非发酵菌6 99株 ,居前 3位的是铜绿假单胞菌 (36 5株 )、鲍氏不动杆菌 (14 1株 )和嗜麦芽寡养单胞菌 (76株 ) ,三者占非发酵菌的 83% ,对哌拉西林 /他唑巴坦的抗菌活性最强 ,敏感率 70 0 % ,其次是头孢他啶、亚胺培南、左氧氟沙星、环丙沙星和替卡西林 /克拉维酸 ,敏感率分别是 5 7 8%、5 5 4 %、5 5 0 %、5 2 0 %和 5 0 0 % ,其余抗生素敏感率都<5 0 0 % ,一代头孢菌素对常见非发酵菌无效 ,嗜麦芽寡养单胞菌对亚胺培南天然耐药。结论　常见非发酵菌是一类多重耐药且耐药性较高的细菌 ,治疗上最好根据药敏选用抗生素 ,并结合其耐药特点联合应用具有协同作用的不同类型抗生素。     

Antimicrobial susceptibility patterns of Salmonella enterica serotype typhi in eastern Nepal

The aim of the present study was to evaluate antimicrobial susceptibility patterns with special reference to multidrug resistance, susceptibility to ciprofloxacin, and bacteriophage typing of Salmonella enterica serotype Typhi isolated from blood sent for culture in a tertiary-care teaching hospital in eastern Nepal during January 2000-December 2004. In total, 132 strains of S. enterica Typhi, isolated from 2,568 blood culture samples collected from cases of suspected enteric fever, were tested for susceptibility to commonly-used antimicrobials by the disc-diffusion method. There were 35 multidrug-resistant strains. None of the isolates were resistant to ciprofloxacin. Of 52 isolates tested for minimum inhibitory concentration (MIC) of ciprofloxacin, 36 (69.23%) showed reduced susceptibility (MIC >0.25 mg/L). Of 112 strains tested for nalidixic acid susceptibility, 86 (76%) were resistant. Strains with reduced susceptibility to ciprofloxacin and resistance to nalidixic acid could be correlated. The commonest phage type was El. Nalidixic acid susceptibility could be a useful screening test for the detection of decreased susceptibility of S. Typhi to ciprofloxacin, a drug which is commonly used even for minor ailments in this area.     

Sensibilité aux antibiotiques des souches de staphylocoques et d’entérocoques isolées en pédiatrie

Objectives – This 4 month study was made in six French pediatric centers, to assess the antimicrobial resistance of Gram-positive cocci. Methods – Staphylococcus aureus, enterococci, and coagulase negative staphylococci (CNS) were collected from June to October 1998. Only CNS isolated from blood samples were studied. Results – Methicillin resistance reached 7.8% for S. aureus isolates and 63% for CNS. About 41% of S. aureus strains were resistant to gentamicin, and all strains were susceptible to glycopeptides. CNS were more resistant to all antibiotics than S. aureus, except for pefloxacin. A decreased susceptibility to teicoplanin was observed in 3.3% of strains and only one strain was resistant. Among the 925 enterococci, seven strains (0.86%) had a VanA phenotype and only one had a VanB phenotype. Conclusions – These results prove the higher resistance of CNS. However, the resistance to glycopeptides of Gram positive cocci  remains low pediatrics in France.     

凝固酶阴性葡萄球菌的青霉素结合蛋白产生和苯唑西林MIC相关性研究

目的分析凝固酶阴性葡萄球菌(CNS)的青霉素结合蛋白2a(PBP2a)的产生和苯唑西林MIC相关性. 方法收集82株临床分离株,采用MRSA胶乳凝集法、MIC法分别检测CNS对苯唑西林的耐药性,比较各试验结果. 结果苯唑西林MIC≥0.5 mg/L或产生PBP2a的表皮葡萄球菌和溶血葡萄球菌均能正确地表示苯唑西林耐药;苯唑西林MIC≥0.5 mg/L解释标准对头葡萄球菌、腐生葡萄球菌、人葡萄球菌、模仿葡萄球菌等CNS评价苯唑西林为耐药,正确性很低,有80.0%未产生PBP2a的菌苯唑西林MIC≥0.5 mg/L,使这些菌被错误地报道苯唑西林耐药. 结论新的苯唑西林解释标准对产生PBP2a的CNS均能正确地评价,而对未产生PBP2a的CNS某些菌种缺乏特异性;MRSA胶乳凝集试剂盒可快速、准确地检测耐苯唑西林的CNS.     

124株嗜麦芽寡养单胞菌的分布及耐药性

目的 了解医院嗜麦芽寡养单胞菌的耐药性及其分布,为临床治疗及控制医院感染提供依据.方法 采用 WalkAway 96 PLUS自动化微生物鉴定仪进行细菌鉴定及药敏试验,回顾性分析2010年6月-2011年4月临床分离的124株嗜麦芽寡养单胞菌耐药率及分布.结果 收集的124株嗜麦芽寡养单胞菌中,对头孢他啶、替卡西林/克拉维酸、磺胺甲噁唑/甲氧苄啶和左氧氟沙星的耐药率分别为46.8％、30.6％、12.1％和9.7％;124株嗜麦芽寡养单胞菌科室分布主要为重症监护病房占70.2％;标本来源主要为痰标本占89.5％.结论 嗜麦芽寡养单胞菌是重症监护病房痰液标本中常见的非发酵革兰阴性杆菌,临床上应根据约敏结果合理选用抗菌药物.     

哺乳期乳腺脓肿病原菌分布及耐药情况

目的了解哺乳期乳腺脓肿患者病原菌分布及其耐药情况,以指导临床医生进行合理治疗。方法回顾性分析2015年1月—2016年12月某专科医院哺乳期乳腺脓肿患者脓液分离病原菌及其药敏结果。结果共收集142例哺乳期乳腺脓肿患者脓液标本,其中98份脓液标本分离病原菌99株,金黄色葡萄球菌94株(94/99,94.95%),耐甲氧西林金黄色葡萄球菌(MRSA)43株(43/94,45.74%),肺炎克雷伯菌2株,表皮葡萄球菌、粪肠球菌和彭氏变形杆菌各1株。金黄色葡萄球菌对青霉素耐药率高达90.43%,对红霉素、克林霉素、四环素耐药率分别为55.32%、39.36%和27.66%,对环丙沙星、莫匹罗星、复方磺胺甲口恶唑、阿米卡星耐药率相对较低,尚未发现耐万古霉素、夫西地酸、替考拉宁、奎奴普丁/达福普汀、利奈唑胺菌株;43株MRSA对红霉素、克林霉素、四环素耐药率分别为83.72%、72.09%和44.19%。结论引起哺乳期乳腺脓肿的病原菌主要为金黄色葡萄球菌,其对青霉素、红霉素、克林霉素和四环素耐药率相对较高,不应经验性选择上述药物治疗乳腺脓肿;同时,应警惕MRSA感染存在的可能,根据药敏结果合理选择抗菌药物,对暂停哺乳者进行母乳移除的指导。     

193株嗜麦芽寡养单胞菌的临床特点及药敏分析

目的 研究嗜麦芽寡养单胞菌的临床特点和耐药性.方法 采用VITEK 2全自动微生物鉴定仪对193株嗜麦芽寡养单胞菌进行分离鉴定与药敏试验,并对其标本来源、科室分布和耐药性进行回顾性分析.结果 193株嗜麦芽寡养单胞菌标本来源以痰液最多,占91.7％,其次为尿液,占4.1％;科室分布以ICU最高,占59.6％,其次为呼吸内科及神经内科,占15.0％、12.4％;嗜麦芽寡养单胞菌对左氧氟沙星和磺胺甲噁唑/甲氧苄啶敏感性较高,其敏感率分别为83.4％和78.8％,而对头孢唑林、头孢曲松、阿莫西林、呋喃妥因、亚胺培南、氨曲南和氨苄西林/舒巴坦耐药性较高,耐药率为92.2％～99.0％;对哌拉西林/他唑巴坦虽敏感率为44.6％,但中介率达41.9％.结论 嗜麦芽寡养单胞菌对多种临床常见抗菌药物呈现不同程度的耐药,加强耐药性监测,为合理经济用药提供理论依据具有重要的参考价值.     

褪色沙雷菌的医院感染分布与耐药性分析

目的 了解褪色沙雷菌在医院感染的临床分布和在ICU与非ICU的耐药性,为临床合理选择和应用抗菌药物提供依据.方法 用K-B法对临床分离出的156株褪色沙雷菌进行体外药物敏感试验并统计分析,同时检测其β-内酰胺酶.结果 分离培养的156株褪色沙雷菌在科室分布,ICU 57株占36.5％、呼吸科52株占33.3％、神经内科28株占17.9％、其他科室19株占12.2％;对亚胺培南、头孢哌酮/舒巴坦的医院平均耐药率分别为3.8％和1.9％,对氨苄西林、头孢唑林、阿莫西林/克拉维酸的耐药率均＞90.0％;检测产AmpC酶菌21株,检出率为13.5％,产ESBLs菌18株,检测率为11.5％,同时产AmpC酶和ESBLs菌7株,检出率为4.5％.结论 ICU分离培养的褪色沙雷菌的耐药率显著高于非ICU分离培养的菌株;AmpC酶和ESBLs的3个表型的检出率ICU明显高于非ICU;褪色沙雷菌耐药机制复杂,对抗菌药物具有多药耐药性,临床应根据药敏试验结果合理选择抗菌药物.     

骨科创伤医院感染革兰阳性球菌的分布及药敏结果

目的 探讨湖北地区3所医院骨科创伤医院感染革兰阳性球菌的菌种分布及对抗菌药物的耐药率,为临床医师控制医院感染选择使用抗菌药物提供实验室依据.方法 感染性标本采集、运送和革兰阳性球菌分离培养严格遵照《全国临床检验操作规程》规则操作;革兰阳性球菌鉴定采用法国生物梅里埃公司生产的VITEK-2 Compact分析仪和配套鉴定卡;药敏监测采用KB法标准.结果 感染性标本中培养出249株革兰阳性球菌,检出前3位的为金黄色葡萄球菌、凝固酶阴性葡萄球菌及粪肠球菌,分别占34.1％ 、25.3％及14.1％;革兰阳性球菌对临床常用抗菌药物的耐药率出现不同程度的上升趋势,但检出的所有革兰阳性球菌对糖肽类抗菌药物100.0％的敏感,未发现糖肽类耐药菌株.结论 骨科创伤医院感染革兰阳性球菌的耐药性已十分严重,大型综合医院应强化抗菌药物的管理工作,预防与控制多药耐药革兰阳性球菌医院感染发生与暴发流行.