Nosocomial methicillin-resistant Staphylococcus aureus bacteremia: is it any worse than nosocomial methicillin-sensitive Staphylococcus aureus bacteremia?

OBJECTIVE: To determine the comparative virulence of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S aureus (MSSA) by consideration of predisposing factors and outcomes in patients infected with these organisms in the healthcare setting. DESIGN: Analysis of an historical cohort of 504 bacteremic patients (316 MSSA and 188 MRSA), examining factors associated with mortality. SETTING: A 916-bed, university-affiliated, tertiary referral hospital. RESULTS: Risk factors for the development of MRSA include male gender, admission due to trauma, immunosuppression, presence of a central vascular line or an indwelling urinary catheter, and a past history of MRSA infection. Overall mortality was 22%. Death due to bacteremia was significantly greater in the MRSA group (risk ratio, 1.68; P<.05), although these patients were not found to be more likely to die due to underlying disease during treatment of bacteremia. In those patients who recovered from bacteremia, no significant differences for the outcome of death could be determined between the MRSA and MSSA groups. CONCLUSIONS: There is a general consensus in the published literature that MRSA bacteremia is more likely to be associated with death, and we confirm this conclusion. However, in contrast to other studies, our MRSA cohort does not appear to be more at risk of death due to underlying disease during treatment for bacteremia. Similarly, the general consensus that MRSA patients have an increased overall mortality was not confirmed in our study. Differences in comorbidities of patients may provide some explanation of these conflicting results, while an alternate explanation is that MRSA strains are more virulent than MSSA in some centers. Perhaps the most plausible explanation is that treatment is provided earlier and in a more aggressive fashion in some centers, leading to an overall lower mortality rate in all staphylococcal bacteremias in these institutions.     

Costs and outcomes among hemodialysis-dependent patients with methicillin-resistant or methicillin-susceptible Staphylococcus aureus bacteremia.

OBJECTIVE: Comorbid conditions have complicated previous analyses of the consequences of methicillin resistance for costs and outcomes of Staphylococcus aureus bacteremia. We compared costs and outcomes of methicillin resistance in patients with S. aureus bacteremia and a single chronic condition. DESIGN, SETTING, AND PATIENTS: We conducted a prospective cohort study of hemodialysis-dependent patients with end-stage renal disease and S. aureus bacteremia hospitalized between July 1996 and August 2001. We used propensity scores to reduce bias when comparing patients with methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) S. aureus bacteremia. Outcome measures were resource use, direct medical costs, and clinical outcomes at 12 weeks after initial hospitalization. RESULTS: Fifty-four patients (37.8%) had MRSA and 89 patients (62.2%) had MSSA. Compared with patients with MSSA bacteremia, patients with MRSA bacteremia were more likely to have acquired the infection while hospitalized for another condition (27.8% vs 12.4%; P = .02). To attribute all inpatient costs to S. aureus bacteremia, we limited the analysis to 105 patients admitted for suspected S. aureus bacteremia from a community setting. Adjusted costs were higher for MRSA bacteremia for the initial hospitalization (21,251 dollars vs 13,978 dollars; P = .012) and after 12 weeks (25,518 dollars vs 17,354 dollars; P = .015). At 12 weeks, patients with MRSA bacteremia were more likely to die (adjusted odds ratio, 5.4; 95% confidence interval, 1.5 to 18.7) than were patients with MSSA bacteremia. CONCLUSIONS: Community-dwelling, hemodialysis-dependent patients hospitalized with MRSA bacteremia face a higher mortality risk, longer hospital stays, and higher inpatient costs than do patients with MSSA bacteremia.     

苏州市154株金黄色葡萄球菌耐药监测及脉冲场凝胶电泳分型

目的 分析苏州市2014 - 2017年金黄色葡萄球菌（staphylococcus aureus, SAU）的耐药情况和耐甲氧西林金黄色葡萄球菌（methicillin - resistance staphylococcus aureus,MRSA）的脉冲场凝胶电泳（pulsed - field gel electrophoresis, PFGE）分型特征,为临床合理使用抗生素提供参考,为MRSA感染溯源提供技术支持。方法 主要采用MIC法对常见的19种抗生素进行药敏试验,对检测为MRSA的菌株进行PFGE分析。结果 SAU耐药率达到93.5%,未发现万古霉素、达托霉素、奎奴普汀/达福普丁和利奈唑胺的耐药菌株。MRSA多重耐药率达到96.2%。MRSA对多种抗生素的耐药率明显高于甲氧西林敏感金黄色葡萄球菌,且差异具有统计学意义（P＜0.05）。26株MRSA共有15个PFGE型别,有3株100%同源的菌株来自同一所医院3位不同病人。结论 苏州市SAU除对万古霉素、达托霉素、奎奴普汀/达福普丁和利奈唑胺敏感外,对其他抗生素均发现耐药现象,MRSA多重耐药率较高。因此,应用抗生素治疗时建议进行药敏试验。MRSA的PFGE基因型别呈现分布多样性,存在院内传播的可能性,应加强PFGE在溯源分析中的应用。     

治疗耐甲氧西林金黄色葡萄球菌感染的新型药物

耐甲氧西林金黄色葡萄球菌（MRSA）感染是现今医院感染控制的一大难题,目前临床常用治疗药物如万古霉素、替考拉宁存在毒性大、费用高等缺点,因此开发新型抗菌药物及治疗手段成为新的趋势,目前已有研究证实达托霉素、特地唑胺和达巴万星等药物可能具有一定的效果。本文对MRSA治疗的新型药物进行综述,以期为临床治疗提供参考。     

A Report on The First Case of Vancomycin-Intermediate Staphylococcus aureus (VISA) in Hawai‘i

The state of Hawai‘i has the highest prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infection in the United States. Since vancomycin is the most frequently-prescribed antibiotic for healthcare-associated MRSA infection, there is concern for development of vancomycin resistance. We report on a 61 year-old woman with history of previous successful treatments of MRSA bacteremia with vancomycin. She was later hospitalized for catheter-related MRSA bacteremia that persisted despite vancomycin treatment. The vancomycin minimal inhibitory concentration (MIC) was initially 1–2 µg/ml, suggesting susceptibility, but changed to 4µg/ml. At this level, the organism was classified as a vancomycin-intermediate Staphylococcus aureus (VISA). Therapy was changed from vancomycin to daptomycin, and the patient''s blood cultures were sterilized. High suspicion of VISA should be raised in MRSA-infected patients who fail or have a history of vancomycin therapy so that additional susceptibility testing and appropriate antibiotic therapy can be promptly commenced to reduce the morbidity associated with VISA infection.     

The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges.

OBJECTIVE: To evaluate the impact of methicillin resistance in Staphylococcus aureus on mortality, length of hospitalization, and hospital charges. DESIGN: A cohort study of patients admitted to the hospital between July 1, 1997, and June 1, 2000, who had clinically significant S. aureus bloodstream infections. SETTING: A 630-bed, urban, tertiary-care teaching hospital in Boston, Massachusetts. PATIENTS: Three hundred forty-eight patients with S. aureus bacteremia were studied; 96 patients had methicillin-resistant S. aureus (MRSA). Patients with methicillin-susceptible S. aureus (MSSA) and MRSA were similar regarding gender, percentage of nosocomial acquisition, length of hospitalization, ICU admission, and surgery before S. aureus bacteremia. They differed regarding age, comorbidities, and illness severity score. RESULTS: Similar numbers of MRSA and MSSA patients died (22.9% vs 19.8%; P = .53). Both the median length of hospitalization after S. aureus bacteremia for patients who survived and the median hospital charges after S. aureus bacteremia were significantly increased in MRSA patients (7 vs 9 days, P = .045; 19,212 dollars vs 26,424 dollars, P = .008). After multivariable analysis, compared with MSSA bacteremia, MRSA bacteremia remained associated with increased length of hospitalization (1.29 fold; P = .016) and hospital charges (1.36 fold; P = .017). MRSA bacteremia had a median attributable length of stay of 2 days and a median attributable hospital charge of 6916 dollars. CONCLUSION: Methicillin resistance in S. aureus bacteremia is associated with significant increases in length of hospitalization and hospital charges.     

老年耐甲氧西林金黄色葡萄球菌性肺炎临床研究

目的 对老年耐甲氧西林金黄色葡萄球菌(MRSA)性肺炎进行临床研究,以期指导临床治疗.方法 对2008年1月-2010年12月广州市第一人民医院、广州医学院附属第二医院住院确诊为耐甲氧西林肺炎的老年患者的一般资料进行描述性研究,对抗菌药物使用情况及不良反应进行分析,对其预后进行x2研究.结果 老年MRSA肺炎患者死亡率为32.9％；抗菌药物未覆盖MRSA,是抗菌药物治疗失败的最主要原因之一,万古霉素治疗组死亡率为41.3％,高于替考拉宁组的26.3％和利奈唑胺组的22.2％,但差异无统计学意义,万古霉素组不良反应发生率为21.7％,显著高于替考拉宁组的5.3％和利奈唑胺组的3.7％,差异均有统计学意义(P＜0.05)；高龄、严重低蛋白血症、肾功能异常、慢性阻塞性肺疾病是导致老年MRSA死亡的重要危险因素,差异均有统计学意义(均P＜0.05).结论 老年MRSA肺炎患者死亡率高,合理使用抗菌药物,积极改善患者基础情况,将有可能改善其预后.     

MRSA医院感染及耐药性研究

目的 了解耐甲氧西林金黄色葡萄球菌(MRSA)医院感染及耐药性的情况.方法 采用回顾性调查方法,对医院在2008年1月-2010年12月住院期间确诊为MRSA医院感染的患者进行分析.结果 MRSA医院感染133例,149例次,其中下呼吸道感染105例,占70.5％,菌血症8例,占5.4％,表浅切口7例,占4.7％;多集中在神经外科、综合ICU和干部病房;未发现对万古霉素、替考拉宁、利奈唑胺耐药株.结论 MRSA是医院感染的重要致病菌,了解其临床分布,加强耐药监测,规范临床用药,可有效预防耐药菌的产生.     

Intermediate vancomycin susceptibility in a community-associated MRSA clone

We describe a case of treatment failure caused by a strain of USA300 community-associated methicillin-resistant Staphylococcus aureus (MRSA) with intermediate susceptibility to vancomycin and reduced susceptibility to daptomycin. The strain was isolated from the bone of a 56-year-old man with lumbar osteomyelitis after a 6-week treatment course of vancomycin for catheter-associated septic thrombophlebitis.     

Methicillin-resistant and -susceptible Staphylococcus aureus sequence type 398 in pigs and humans

Methicillin-resistant Staphylococcus aureus sequence type 398 (ST398 MRSA) was identified in Dutch pigs and pig farmers. ST398 methicillin-susceptible S. aureus circulates among humans at low frequency (0.2%) but was isolated in 3 human cases of bacteremia (2.1%; p = 0.026). Although its natural host is probably porcine, ST398 MRSA likely causes infections in humans.     

重症监护室耐甲氧西林金黄色葡萄球菌监控研究

目的了解某院重症监护室（ICU）耐甲氧西林金黄色葡萄球菌（MRSA）医院感染情况,评价干预效果。方法收集2008年8月-2010年9月间ICU住院患者MRSA医院感染病例,对分离的阳性菌株用分子生物学方法验证。2009年9月-2010年9月,对ICU MRSA医院感染患者实施具体干预、监控,并与干预前一年的MRSA医院感染率进行比较,评价干预效果。结果ICU环境中MRSA检出率,干预前为29.90%（87/291）,干预后为7.90%（23/291）,两者比较,差异有统计学意义(χ2=45.910,P＜0.05); ICU住院患者MRSA医院感染率,干预前为35.87％（113/315）,干预后为14.66%(51/348),两者比较,差异有统计学意义(χ2=25.11,P＜0.05)。干预前后ICU内的MRSA感染危险因素相同,主要是气管插管及使用呼吸机等侵入性操作、神经外科大手术、广谱抗菌药物的长期使用、免疫抑制剂的应用和未采取隔离措施等。MRSA新发感染主要集中在入住ICU 2周后,入住时间越长,干预效果越不明显。结论ICU获得性感染MRSA发生率较高。早期强化干预措施,加强监测、控制,可有效降低MRSA医院交叉感染率。     

Changing epidemiology of community-onset methicillin-resistant Staphylococcus aureus bacteremia.

OBJECTIVES: To review cases of community-onset Staphylococcus aureus bacteremia and to evaluate whether the risk factors and epidemiology of methicillin-resistant S. aureus (MRSA) bacteremia have changed from early reports. DESIGN: Retrospective case-comparison study of community-onset MRSA (n = 26) and methicillin-susceptible S. aureus (MSSA) (n = 26) bacteremias at our institution. SETTING: A 600-bed urban academic medical center. PATIENTS: Twenty-six patients with community-onset MRSA bacteremia were compared with 26 patients with community-onset MSSA bacteremia. Molecular analysis was performed on S. aureus isolates from the 26 MRSA cases as well as from 13 cases of community-onset S. aureus bacteremia from 1980 and 9 cases of nosocomial S. aureus bacteremia from 2001. RESULTS: The two groups were similar except that patients with MRSA bacteremia were more likely to have presented from a long-term-care facility (26.9% vs 4%; P = .05) and to have had multiple admissions within the preceding year (46% vs 15%; P = .03). Clamped homogeneous electric fields analysis of MRSA isolates from 1982 revealed predominantly that one clone was the epidemic strain, whereas there were 14 unique strains among current community-onset isolates. Among current nosocomial isolates, 3 patterns were identified, all of which were present in the community-onset cases. CONCLUSIONS: Previously described risk factors for MRSA acquisition may not be helpful in predicting disease due to the polyclonal spread of MRSA in the community. Unlike early outbreaks of MRSA in patients presenting from the community, current acquisition appears to be polyclonal and is usually related to contact with the healthcare system.     

Risk factors for nosocomial infective endocarditis in patients with methicillin-resistant Staphylococcus aureus bacteremia.

BACKGROUND AND OBJECTIVE: Nosocomial infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are increasing. Only a few studies of MRSA infective endocarditis have been conducted, and none have reported its risk factors. We sought to determine the host-related risk factors for infective endocarditis in patients with nosocomial MRSA bacteremia. SETTING: A 2,000-bed, university-affiliated, tertiary-care hospital. PATIENTS: Thirty-one patients with nosocomial MRSA infective endocarditis between October 1996 and May 2003. DESIGN: A retrospective chart review was conducted. Data were compared with those from a control group of patients with nosocomial MRSA bacteremia. Logistic regression was used to identify independent risk factors for nosocomial infective endocarditis. RESULTS: Compared with patients who had nosocomial MRSA bacteremia and no infective endocarditis, patients who had infective endocarditis had a higher incidence of chronic liver disease and a lower incidence of immunodeficiency. The risk of developing infective endocarditis was approximately 10% for patients with nosocomial MRSA bacteremia. CONCLUSION: Patients with MRSA bacteremia and underlying chronic liver disease were prone to infective endocarditis.     

Staphylococcus aureus bacteremia in older adults: predictors of 7-day mortality and infection with a methicillin-resistant strain.

OBJECTIVES: To determine the predictors of 7-day mortality in older adult patients with Staphylococcus aureus bacteremia after controlling for comorbidity using the Charlson weighted index of comorbidity (WIC) and to identify the risk factors associated with bacteremia due to methicillin-resistant S. aureus (MRSA). DESIGN. Retrospective cohort study from January 2003 until December 2004. SETTING. Two tertiary care, university-affiliated hospitals. METHODS. One hundred thirty-five hospitalized patients with S. aureus bacteremia were included in the study. All patients who were 60 years or older and had 1 or more blood cultures positive for S. aureus were included in the study. The primary outcome was death 7 days after the onset of S. aureus bacteremia. RESULTS. Twenty-one patients (15.6%) died within 7 days after the onset of S. aureus bacteremia. Seventy-four patients (56.1%) had MRSA bacteremia. Multivariate analysis identified 3 independent determinants of 7-day mortality: Charlson WIC score greater than 5 (odds ratio [OR], 3.6 [95% confidence interval {CI}, 1.1-11.2]; P=.03), previous hospitalization in the past 3 months (OR, 5.0 [95% CI, 1.1-25.1]; P=.04), and altered mental status at the onset of S. aureus bacteremia (OR, 13.6 [95% CI, 2.9-64.6]; P=.001). Multivariate analysis identified previous hospitalization in the past 3 months (OR, 2.6 [95% CI, 1.1-5.9]; P=.02), residence in a long-term care facility (OR, 4.5 [95% CI, 1.7-12.3]; P=.003), and altered mental status at the onset of S. aureus bacteremia (OR, 2.5 [95% CI, 1.5-5.6]; P=.02) to be independently associated with the presence of MRSA. CONCLUSIONS: The Charlson WIC is significantly associated with increased mortality of S. aureus bacteremia in older adults. Previous hospitalization in the past 3 months, residence in a long-term care facility, and altered mental status should be used as a guidance for empirical vancomycin therapy and application of infection control measures in older adults with suspected S. aureus bacteremia.     

2010年某儿童医院耐甲氧西林金黄色葡萄球菌感染临床分析

目的了解2010年某儿童医院耐甲氧西林金黄色葡萄球菌(MRSA)感染、预后情况及特殊群体儿童与普通儿童MRSA感染的临床特点。方法按常规方法进行细菌的分离与鉴定,细菌药物敏感试验采用纸片扩散(Kirby-Baner)法。患儿分组根据其来源及卫生部颁布的《医院感染诊断标准(试行)》进行。结果该儿童医院2010年收治病史完整的MRSA感染病例66例,其中30例为来自上海市儿童福利院(护理院)的救治弃婴。社区感染组以新生儿及接触感染者为主;护理院感染组相关因素包括重度营养不良、术后切口感染、先前住院史、长期卧床/局部压迫等;医院感染组与恶性肿瘤术后化疗、长期经鼻留置胃管、近期手术、气管插管/机械通气有关。平均住院天数为40 d。预后:社区感染组全部好转,治愈出院;护理院感染组有2例死亡,病死率6.67%;医院感染组6例中有3例死亡,占50%。结论来自护理院的患儿与来自社区的普通患儿MRSA感染情况有显著差异,在综合性儿童医院中对此类特殊患者设立独立病房进行隔离治疗,是有效减少社区获得性MRSA与医院获得性MR-SA的交叉感染,降低综合性医院医院感染的有效措施。     

Staphylococcus aureus bacteremia, Australia

Staphylococcus aureus bacteremia (SAB) is common and increasing worldwide. A retrospective review was undertaken to quantify the number of cases, their place of acquisition, and the proportions caused by methicillin-resistant S. aureus (MRSA) in 17 hospitals in Australia. Of 3,192 episodes, 1,571 (49%) were community onset. MRSA caused 40% of hospital-onset episodes and 12% of community-onset episodes. The median rate of SAB was 1.48/1,000 admissions (range 0.61-3.24; median rate for hospital-onset SAB was 0.7/1,000 and for community onset 0.8/1,000 admissions). Using these rates, we estimate that approximately 6,900 episodes of SAB occur annually in Australia (35/100,000 population). SAB is common, and a substantial proportion of cases may be preventable. The epidemiology is evolving, with >10% of community-onset SAB now caused by MRSA. This is an emerging infectious disease concern and is likely to impact on empiric antimicrobial drug prescribing in suspected cases of SAB.     

耐甲氧西林金黄色葡萄球菌的临床感染特点及耐药特性

目的 了解耐甲氧西林金黄色葡萄球菌(MRSA)感染状况,为有效预防与控制多药耐药菌医院感染及合理使用抗菌药物奠定基础.方法 前瞻性调查方法,由医院感染专职人员定期到微生物实验室获取培养阳性结果,深入临床了解患者用药、消毒隔离措施及医务人员个人防护措施落实情况;并对临床感染资料和病原菌耐药性进行统计分析.结果 2009年11月-2010年12月共分离出126株金黄色葡萄球菌,其中86株为耐甲氧西林金黄色葡萄球菌;医院感染病例中ICU感染病例占70.83％;MRSA仅对磺胺甲噁唑/甲氧苄啶、替考拉宁、万古霉素、喹奴普汀/达福普汀有较高的敏感率,分别为93.02％、97.67％、96.51％、93.02％.结论 MRSA医院感染率有明显上升趋势,且呈多耐药性;应加强多药耐药菌的医院感染预防与控制工作,积极开展多药耐药菌的主动筛查工作,做到早发现、早隔离、早治疗;提高MRSA的治愈率,减少MRSA的医院感染和死亡率.     

Illicit Drug Use and Risk for USA300 Methicillin-Resistant Staphylococcus aureus Infections with Bacteremia

To assess the association of illicit drug use and USA300 methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, a multicenter study was conducted at 4 Veterans Affairs medical centers during 2004–2008. The study showed that users of illicit drugs were more likely to have USA300 MRSA bacteremia (in contrast to bacteremia caused by other S. aureus strains) than were patients who did not use illicit drugs (adjusted relative risk 3.0; 95% confidence interval 1.9–4.4). The association of illicit drug use with USA300 MRSA bacteremia decreased over time (p = 0.23 for trend). Notably, the proportion of patients with USA300 MRSA bacteremia who did not use illicit drugs increased over time. This finding suggests that this strain has spread from users of illicit drugs to other populations.Infections caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) are increasing. Outbreaks have been described in a variety of populations, including sports teams, men who have sex with men, prisoners, and children (1–10). The USA300 MRSA clone has been recognized as the most common strain causing CA-MRSA infections (11).CA-MRSA was first reported in illicit drug users in Detroit in 1980 (12). The drug-using population has been identified as a reservoir of CA-MRSA (13). Because of the repeated injection or inhalation of drugs, the opportunity for a person to cause and spread infection with one’s own colonizing strain is multiplied (13,14). Skin and soft tissue infections are the most common infections in illicit drug users; the USA300 MRSA strain is the cause of up to 75% of these infections (13–15). Once this strain colonizes or otherwise infects a person, it can then enter the patient’s bloodstream and become a potentially life-threatening bloodstream infection.If admitted to the hospital, illicit drug–using patients with a USA300 MRSA infection complicated by bacteremia serve as a potential reservoir for transmission to other patient populations. This mechanism may be contributing to the replacement of other MRSA strains typically associated with nosocomial infections by USA300 MRSA and may aid this strain in becoming the predominant isolate causing MRSA infections in both healthcare and community settings (16,17). The objective of this study was to evaluate the association of illicit drug use with USA300 MRSA bacteremia and whether the association is static or has changed over a 5-year period as the USA300 MRSA epidemic has progressed.     

Methicillin-Resistant and -Susceptible Staphylococcus aureus Infections in Dogs

Methicillin-resistant Staphylococcus aureus (MRSA) has become a pathogen of animals. To compare types of infections, clinical outcomes, and risk factors associated with MRSA in dogs with those associated with methicillin-susceptible Staphylococcus aureus (MSSA) infections, we conducted a case–control study at 3 veterinary referral hospitals in the United States and Canada during 2001–2007. Risk factors analyzed were signalment, medical and surgical history, and infection site. Among 40 dogs with MRSA and 80 with MSSA infections, highest prevalence of both infections was found in skin and ears. Although most (92.3%) dogs with MRSA infections were discharged from the hospital, we found that significant risk factors for MRSA infection were receipt of antimicrobial drugs (odds ratio [OR] 3.84, p = 0.02), β-lactams (OR 3.58, p = 0.04), or fluoroquinolones (OR 5.34, p = 0.01), and intravenous catheterization (OR 3.72, p = 0.02). Prudent use of antimicrobial drugs in veterinary hospitals is advised.     

骨科患者医院获得性感染金黄色葡萄球菌的危险因素与耐药性研究

目的探讨骨科患者医院获得性感染金黄色葡萄球菌(SA)的危险因素与耐药性,为临床治疗提供依据。方法以143例骨科获得性感染SA患者为观察组,并选取同时期未发生感染的住院患者100例为对照组,分析SA主要感染部位、相关危险因素、耐甲氧西林(MRSA)情况及对常用抗菌药物的耐药性。结果SA主要感染部位为手术切口,占56.7%。观察组与对照组比较分析,显示患者年龄≥60岁、合并基础疾病、使用激素治疗、进行侵入性诊疗等均是引起SA感染的相关危险因素(P<0.05)。143株SA中,MRSA占25.2%。MRSA对青霉素G、头孢西丁、苯唑西林100.0%耐药,MRSA多药耐药率明显高于MSSA(P<0.05),未发现对替考拉宁、万古霉素、利奈唑胺耐药的SA。结论临床应针对骨科SA感染部位及相关危险因素采取预防性措施,从而降低医院感染的发生。从骨科患者中分离出的MRSA呈多重耐药,临床应加强MRSA耐药性监测。