皮肤科耐甲氧西林金黄色葡萄球菌临床分布特点及耐药性分析

目的 探讨皮肤软组织分泌物中耐甲氧西林金黄色葡萄球菌(MRSA)的临床分布特点及耐药性分析,为皮肤科防治MRSA提供理论依据。方法 回顾性分析2015年1月-2021年9月本院皮肤性病科皮肤软组织创面分离培养出的金黄色葡萄球菌和MRSA。采用法国生物梅里埃公司的全自动微生物分析鉴定仪(VITEK-2 Compact)鉴定菌种,应用该仪器配套的药敏卡进行微量肉汤稀释法检测菌株的MIC。药物敏感结果判读按照CLSI M100标准执行。结果 在2015年1月-2021年9月期间,分离出899株金黄色葡萄球菌,其中282株(检出率31.37%)为MRSA,由201株社区获得性MRSA(CA-MRSA)和81株医院感染性MRSA(HA-MRSA)组成。CA-MRSA在总MRSA感染中的平均检出率为71.28%(201/282),为主要感染菌,其检出率逐年升高;与CA-MRSA感染患者相比,HA-MRSA感染患者年龄明显偏大(P<0.001),且其感染率逐年升高(P=0.035),但其在性别上没有男女差异;抗生素敏感性方面,HA-MRSA和CA-MRSA对万古霉素、替考拉宁、替加环素、利奈唑...     

艾滋病患者机会性感染金黄色葡萄球菌与耐药性分析

目的分析本院(2013～2018)年艾滋病患者机会性感染金黄色葡萄球菌及耐甲氧西林金黄色葡萄球菌(MRSA)的耐药情况,为临床抗生素的合理使用提供数据支持。方法收集(2013～2018)年本院收治的艾滋病患者样本培养出金黄色葡萄球菌,对其耐药性及MRSA的试验结果进行回顾性分析。结果在136名艾滋病患者中共收集金黄色葡萄球菌160株;各类标本中,痰类标本检出率最高,占40.6%,其次是血液标本(16.9%),对β-内酰胺类和大环内酯类药物有较高的耐药性;其中检出MRSA 29株,各类标本中痰标本检出率最高,占34.5%,其次是分泌物标本(27.6%),其对β-内酰胺类和大环内酯类药物均为高度耐药,呈多重耐药性。本次研究的160株金黄色葡萄球菌对噁唑烷酮类、糖肽类、四环素类中的替加环素和呋喃类药物在本院目前均未发现耐药。结论临床应根据药敏结果合理选择使用抗生素,有效控制金黄色葡萄球菌,特别是MRSA的感染和暴发流行。     

新生儿皮肤金黄色葡萄球菌感染的耐药性检测

目的：检测母婴同室新生儿皮肤金黄色葡萄球菌（简称金葡菌）感染的耐药状况。方法：对2009年1月至2010年12月206例皮肤感染的新生儿皮损分泌物进行细菌培养,应用琼脂稀释法检坝419种抗生素对金葡菌的最小抑菌浓度。结果：培养出金葡菌45株,分离率29．22％;其耐药率前3位依次为青霉素、氨苄西林和红霉素。结论：新生儿金葡菌的检出率与国内其他研究相似,治疗首选半合成青霉素或头孢类抗生素。     

男性性病患者尿道金黄色葡萄球菌检测及耐药性分析

我们对2002年1月～2003年11月来我院就诊的男性性病患者进行尿道金黄色葡萄球菌检测，并将该菌对常用抗菌药物的耐药性进行分析。报道如下。     

常见皮肤病皮损金黄色葡萄球菌的检测及耐药性分析

目的：分析常见皮肤病皮损中细菌的检出情况及耐药性。方法：对本院皮肤科住院患者皮损的细菌培养结果进行统计分析。结果：180株阳性菌中,金黄色葡萄球菌（SA）128株,其中耐甲氧西林金黄色葡萄球菌（MRSA）37株（28．91％,37／128）。SA及MRSA对抗生素的敏感率以万古霉素、喹奴普汀-达福普汀、利奈唑胺、替加环素、替考拉宁最高（100％）。结论：SA与一部分可疑细菌感染性皮肤病可能有一定的关系。MRSA感染率高,耐药现象严重,临床应根据药敏结果合理选用抗菌药物。     

解脲支原体的感染状况和耐药性分析

目的:了解包头地区性病门诊支原体感染的状况和药敏情况。方法:应用试剂盒对解脲支原体进行检测,并对10种药物的耐药情况进行分析。结果:1434例泌尿生殖道炎患者解脲支原体总检出率为43.44%,女性解脲支原体检出率62.72%,男性解脲支原体检出率为34.46%。耐药率从低到高依次为甲砜霉素、克拉霉素、交沙霉素、司帕沙星、美满霉素、强力霉素、罗红霉素、阿奇霉素、大观霉素、林可霉素。敏感率由高到低依次为克拉霉素、美满霉素、强力霉素、甲砜霉素、司帕沙星、交沙霉素、大观霉素、罗红霉素、阿奇霉素、林可霉素。结论:解脲支原体是该类疾病的主要病原体,在女性泌尿生殖道炎的病原检测中应把解脲支原体列为常规必检项目;对于解脲支原体阳性的患者应做药物敏感试验,以指导临床应用敏感的抗菌药物,减少耐药株产生。     

武汉地区门诊皮肤软组织感染患者中甲氧西林敏感金黄色葡萄球菌PVL基因携带及耐药性检测

目的 探讨从武汉地区门诊皮肤软组织感染（SSTI）患者中分离的甲氧西林敏感金黄色葡萄球菌（MSSA）携带杀白细胞毒素（PVL）基因及耐药特征。 方法 收集2011—2013年在武汉市5所医疗机构门诊就诊SSTI患者中分离的182株MSSA,采用纸片扩散法进行药敏试验,多重PCR法检测mecA基因和PVL基因。结果 182株MSSA中有65株PVL阳性,阳性率为35.71%。不同病种PVL阳性率差异有统计学意义（χ2 = 49.76,P = 0.00）,其中疖/痈（7/7）、毛囊炎（3/3）、脓肿（55.53%,30/57）和脓疱疮（2/4）的检出率较高。PVL阳性患者年龄［（35.40 ± 19.31）岁］小于PVL阴性患者［（43.21 ± 20.75）岁］,差异有统计学意义（t = 2.50,P = 0.01）。在65株PVL阳性MSSA菌株中,耐药率居前3位的依次是氨苄西林（87.69%）、青霉素（53.85%）、红霉素（41.54%）。在117株PVL阴性MSSA菌株中,耐药率居前3位的依次是克林霉素（26.50%）、青霉素（20.51%）、氨苄西林（12.82%）。PVL阳性MSSA菌株对青霉素（χ2 = 21.19）、氨苄西林（χ2 = 97.97）、多西环素（χ2 = 11.61）、环丙沙星（χ2 = 8.07）、红霉素（χ2 = 25.04）、庆大霉素（χ2 = 10.86）的耐药率高于PVL阴性MSSA菌株,差异均有统计学意义（P < 0.05）。 结论 武汉地区门诊MSSA SSTI患者中,PVL阳性率较高,对大多数β内酰胺类抗菌药物耐药,经验治疗可选择氟氯西林、复方磺胺甲恶唑片或多西环素。     

过敏性紫癜患者金黄色葡萄球菌的检测及意义

目的 探究金黄色葡萄球菌(简称金葡菌)在各型过敏性紫癜患者中的检测情况及其与临床的关系.方法 对248例过敏性紫癜患者(观察组1)、60例健康人(对照组1)的咽拭子进行金葡菌培养及药敏试验;同时对腹型紫癜(40例)和伴有腹部症状的混合型患者(38例)共78例(观察组2)、60例健康人(对照组2)的大便进行金葡菌培养及药敏试验;根据药敏结果选择抗生素,观察疗效.结果 观察组1与对照组1咽拭子培养金葡菌检出率(8.47%和8.33%)无统计学差异;观察组2与对照组2大便培养金葡菌检出率(5例和2例)有统计学差异.咽拭子金葡菌2+以上者使用敏感抗生素治疗后病情迅速控制.结论 金葡菌菌群的紊乱可能与过敏性紫癜患者尤其是腹型紫癜患者临床症状有一定关系,细菌培养和药敏试验对过敏性紫癜的治疗有重要意义.     

男性泌尿生殖道凝固酶阴性葡萄球菌感染及耐药性分析

目的探讨男性泌尿生殖系凝固酶阴性葡萄球菌(CNS)感染状况及耐药性。方法采用NCCLS制定的方法和标准测定男性泌尿生殖道感染标本中分离培养的74株CNS并进行体外耐药性监测。结果74株CNS中,耐甲氧青霉素葡萄球菌(methicillin resistant staphylococcus,MRS)51株(68.9%),甲氧青霉素敏感葡萄球菌(methicillin sensitiv-ity staphylococcus,MSS)23株(31.1%)。所有MRS对青霉素、甲氧青霉素等多种药物耐药,而对万古霉素和利福平有较高敏感性。结论CNS是男性泌尿生殖系感染的重要病原菌,对此应依据细菌培养及体外药敏监测选择有效抗生素,或在CNS感染治疗时首选万古霉素。     

特应性皮炎患者皮损表面金黄色葡萄球菌培养及药敏分析

目的探索能有效治疗特应性皮炎(AD)患者金黄色葡萄球菌(简称金萄菌)感染的药物。方法检测17种抗生素对AD患者皮损表面金葡菌的药敏试验;以最低抑菌浓度(M IC)和最低杀菌浓度(MBC)试验检测珊瑚姜油、茶树油对AD患者皮损表面培养出的金葡菌的抗菌活性。结果AD患者皮损表面培养出的金葡菌对多种抗生素耐药;珊瑚姜油对AD患者皮损表面培养出的耐青霉素的金葡菌的M IC为0.05%,MBC为0.75%;茶树油的M IC为0.75%,MBC为1.00%。结论AD患者皮损表面培养出的金葡菌对多种抗生素耐药;珊瑚姜油和茶树油对AD患者皮损表面培养出的耐青霉素的金葡菌敏感。     

571例皮肤软组织感染住院患者病原菌分布和耐药性分析

目的:研究我院住院患者中皮肤软组织感染者(SSTI)病原菌分布及耐药性。方法:收集571例我院2018年1月1日至2020年12月31日SSTI病原培养结果阳性的住院患者,分析病原菌分布特点以及主要革兰氏阳性优势菌的耐药情况。结果:患者按病种分类,主要有天疱疮、大疱性类天疱疮、湿疹、银屑病等。571例SSTI患者共培养菌株624株,革兰氏阳性菌529株(占84.8%),革兰氏阴性菌76株(占12.1%),真菌19株(占3.0%);主要优势菌为金黄色葡萄球菌、溶血葡萄球菌、中间葡萄球菌,均对青霉素、红霉素、阿奇霉素明显耐药,对米诺环素和替考拉宁敏感性均为100%。结论:金黄色葡萄球菌、溶血葡萄球菌、中间葡萄球菌为我院SSTI最主要致病菌。革兰氏阳性优势菌对青霉素、红霉素、阿奇霉素等耐药率高,对米诺环素、多西环素、替考拉宁、利奈唑胺等耐药率较低,可以指导临床用药。     

Methicillin resistant Staphylococcus aureus (MRSA): Diagnostic,clinical relevance and therapy

In the last decades, increasing numbers of patients with problematic bacteria such as methicillin‐resistant Staphylococcus aureus (MRSA) have been reported. Beside the common problem of MRSA variants in hospitals, recently community‐based MRSA (cMRSA) has become a growing problem even in patients without typical risk factors. cMRSA often carries the virulence factor Panton‐Valentine‐leukocidin (PVL) causing dermatologic diseases like therapy‐refractory furunculosis in young adults. Thus, it is both a medical and health economic issue to identify MRSA as quickly as possible and then eradiate it completely. We review the practical consequences and in particular, the therapy options which are reasonable once MRSA is identified.     

Prevalence of Staphylococcus aureus and antibiotic resistance in children with atopic dermatitis: a New Zealand experience

Background/Objectives: Children with atopic dermatitis often have infective exacerbations which are treated with antibiotics and/or antiseptics. The most common infective cause is Staphylococcus aureus with a worldwide trend towards antibiotic resistance. This prospective observational audit aimed primarily to establish the prevalence of S. aureus colonisation in New Zealand children with atopic dermatitis attending a specialised paediatric dermatology clinic. Secondary aims were to assess whether S. aureus colonisation correlated to clinical severity, the sensitivity patterns to antibiotics (in particular methicillin‐resistant S. aureus, and to identify any demographic or management risk factors. Methods: Subjects were children aged 18 years or younger attending a tertiary public hospital dermatology clinic with a diagnosis of atopic dermatitis. Demographic and social data, as well as current and previous systemic and topical treatments, were recorded. Patients were examined and the extent of atopic dermatitis determined using a standardised scale (Scoring Atopic Dermatitis (SCORAD)). Two skin swabs were taken for culture and standard sensitivities; one from the left antecubital fossa and one from the worst area of atopic dermatitis. Microbiological cultures and density of S. aureus colonisation were recorded. SCORAD and density of S. aureus culture were correlated. Demographic and clinical data from children with S. aureus was analysed. Results: One hundred children were recruited from March 2007 to May 2008. S. aureus was isolated from68 patients. There was a positive correlation between the density of S. aureus culture and severity of SCORAD (Spearman r = 0.55, P < 0.0001). There was also a positive, though weaker, correlation between SCORAD and ethnicity with Māori /Polynesian children generally having more severe atopic dermatitis (r = 0.22, P = 0.028). Although a greater proportion of Māori or Pacific Island children were colonised by S. aureus than other ethnic groups this did not reach statistical significance (78% and 60%, respectively, P = 0.0842). There was no significant correlation between either S. aureus prevalence or its density and age (r = 0.09, P = 0.39 and r = 0.12, P = 0.23, respectively). There were no significant differences in sex or treatments (use of antibiotics, antiseptics, calcineurin inhibitors, emollients or corticosteroids) between S. aureus‐positive and S. aureus‐negative children. Only 12 S. aureus‐positive children demonstrated antibiotic resistance, 10 to erythromycin and only two to flucloxacillin. Conclusions: Three quarters of children with atopic dermatitis have at least one positive culture, of which the vast majority is S. aureus. The density of S. aureus colonisation correlates to severity of atopic dermatitis. Children who are S. aureus culture‐positive had no significant demographic or clinical features different to children who were culture‐negative. Only two children grew S. aureus resistant to flucloxacillin (2% resistance rate), which remains the ideal first line of treatment in our local population.     

Antimicrobial susceptibility of Staphylococcus aureus isolated from children with impetigo in China from 2003 to 2007 shows community‐associated methicillin‐resistant Staphylococcus aureus to be uncommon and heterogeneous

Background The number of patients with impetigo caused by community‐associated methicillin‐resistant Staphylococcus aureus (CA‐MRSA) has been increasing. Objectives To investigate the antimicrobial susceptibility of S. aureus causing impetigo in children in China from 2003 to 2007 and further characterize isolates of CA‐MRSA. Materials and methods We examined 984 S. aureus isolates for antimicrobial susceptibility to 11 antimicrobials using the agar dilution method. CA‐MRSA isolates were analysed for Panton–Valentine leucocidin (PVL) genes, and staphylococcal cassette chromosome mec (SCCmec) typing was performed. Results The largest proportion (94·5%) of strains were resistant to penicillin, followed by erythromycin (86·2%) and clindamycin (69·6%). In total 772 of 984 (78·5%) S. aureus strains were multiresistant. The incidence of CA‐MRSA was 1·1%, with a high rate of resistance to clindamycin (90·9%) and tetracycline (72·7%), but all were susceptible to ciprofloxacin. The susceptibility profiles of MRSA to other antimicrobial agents were similar to those of methicillin‐sensitive S. aureus (MSSA). None of the S. aureus strains were resistant to vancomycin and fusidic acid; moreover, only one strain was resistant to mupirocin. Typing of the SCCmec showed that 54·5% were type IV, 18·2% were type V and 9·1% were type VI. All the PVL‐positive CA‐MRSA carried SCCmec type IV. Conclusions CA‐MRSA is still relatively uncommon and heterogeneous in children in China. Penicillin and erythromycin are no longer appropriate agents. Effective antibiotic agents for patients with impetigo are mupirocin and fusidic acid.     

High levels of fusidic acid-resistant Staphylococcus aureus in dermatology patients

BACKGROUND: Antibiotic resistance is a significant problem both in hospitals and the community. Topical antibiotics are widely used for dermatological problems and this may be leading to the emergence of resistant bacteria. OBJECTIVE: To assess the level of fusidic acid-resistant Staphylococcus aureus inpatients with dermatological problems. METHODS: All microbiology samples over a 4-month period were tested for antibiotic sensitivities. Patients with cultures positive for S. aureus were studied. RESULTS: The study shows 50% of S. aureus isolates from dermatology patients were resistant to fusidic acid. This figure rose to 78% inpatients with atopic eczema. Of patients with fusidic acid-resistant S. aureus isolates, 96% had used a fusidic acid-containing preparation within the previous 6 months. The level of fusidic acid resistance in S. aureus samples cultured from nondermatology patients was only 9.6%, a level significantly below that for dermatology patients (P < 0.001). CONCLUSIONS: High levels of fusidic acid-resistant S. aureus are found in dermatology patients. Inappropriate use of topical antibiotics in dermatology patients leading to fusidic acid resistance may threaten the efficacy of systemic fusidic acid for the treatment of serious S. aureus infections. Education of health professionals and restriction of the use of fusidic acid is needed.     

Activity of Eight Fluoroquinolones against Both Methicillin-Susceptible and -Resistant Staphylococcus aureus Isolated from Skin Infections

The in vitro susceptibility of Staphylococcus aureus to eight fluoroquinolones, norfloxacin, ofloxacin, enoxacin, ciprofloxacin, lomefloxacin, tosufloxacin, sparfloxacin, and nadifloxacin was established by agar dilution tests, 71 isolates of methicillin-susceptible (MSSA) and 74 isolates of -resistant S. aureus (MRSA) isolated from skin infections. Among all of the fluoroquinolones, nadifloxacin exhibited the lowest MIC for both MSSA and MRSA. In addition, there were no resistant S. aureus, neither MSSA and MRSA, to nadifloxacin. With the exception of nadifloxacin, the incidence of MRSA resistant to fluoroquinolones has gradually increased in recent years. Over half of the MRSA strains were resistant to norfloxacin, ofloxacin, enoxacin, ciprofloxacin, and lomefloxacin.     

北京地区儿童皮肤感染金黄色葡萄球菌的耐药研究

目的 分析儿童皮肤感染金黄色葡萄球菌的耐药现状及社区获得性耐甲氧西林金黄色葡萄球菌的流行情况。方法 对600例感染性皮肤病患儿皮损分泌物进行细菌培养。应用琼脂稀释法检测抗生素及环丙沙星对培养出的金黄色葡萄球菌的最小抑菌浓度。结果 600例患儿皮损共培养出金黄色葡萄球菌451株，对13种抗生素及环丙沙星的药敏试验结果显示，对青霉素耐药率为93.8%，对红霉素耐药率为87.6%，对克林霉素为71.6%，对四环素、氯霉素、庆大霉素和环丙沙星的耐药率依次为37.3%，13.3%，6.4%和2.2%，对苯唑西林、头孢唑啉、头孢呋辛和莫匹罗星耐药率分别为1.6%，0.4%，0.2%和0.2%，未发现头孢曲松、万古霉素和夫西地酸耐药菌株。结论 儿童社区获得性耐甲氧西林金黄色葡萄球菌分离率为1.6%。治疗社区来源的皮肤金黄色葡萄球菌感染性皮肤病，全身治疗首选耐青霉素酶的半合成青霉素和头孢菌素，外用治疗可选择莫匹罗星或夫西地酸。     

Treatment and prevention of community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections

ABSTRACT:   Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a pathogen in the community with a range of clinical manifestations. Although skin and soft tissue infections (SSTIs) are the most common presentation, invasive and more virulent disease has been observed. Colonization and infection with CA-MRSA can occur in individuals with no prior healthcare exposures but also in distinct groups whose common characteristic appears to be close person-to-person contact. Outbreaks with CA-MRSA have occurred in day care centers, athletic teams, and prisons, and transmission has been documented among family members and within the hospital. Treatment of SSTIs involves incision and drainage, oral or parenteral antibiotic therapy, or topical therapy. Healthcare practitioners in outpatient and inpatient settings need to be familiar with prevention and treatment strategies for CA-MRSA.