住院患者与医院环境耐甲氧西林金黄色葡萄球菌耐药性分析

目的]了解耐甲氧西林金黄色葡萄球菌（MRSA）在医院内的流行及耐药特征，为预防和控制MRSA引起的院内感染提供科学依据。方法]以上海某区一家综合性二级医院临床患者标本中分离的78株金黄色葡萄球菌（SA）和同时期该医院诊疗环境中分离的53株sA共131株sA为研究对象，分别用头孢西丁药敏纸片法和PCR法检测MRSA，K-B法检测该131株sA对15种抗菌药物的敏感性。结果]131株SA中，MRSA构成比为55．73％（73／131）。其中，临床分离株和环境分离株中的MRSA构成比分别为52．56％（41／78）和60．38％（32／53），两者相比差异无统计学意义（JP〉0．05）。临床MRSA株主要分布于痰液及伤口分泌物；环境MRSA株主要分布于床头柜、监护仪以及医护人员手。抗菌药物敏感性实验显示，MRSA对β-内酰胺类药物耐药率100％，对糖肽类药物、利奈唑胺、利福平高度敏感，对其他抗菌药物均呈多重耐药。结论]MRSA在医院内有较高流行度，而且呈多重耐药性。应加强抗生素的合理使用，及时进行MRSA院内感染目标性监测，切实做好MRSA感染患者的消毒隔离工作。

Antimicrobial Resistance in Staphylococcus Aureus Isolated from Inpatients and Hospital Environment

Objective ] To investigate the prevalence and antimicrobial susceptibility of methicillin-resistant Staphylococcus aureus （MRSA） in hospital, and to provide scientific basis for the prevention and control of MRSA nosocomial infection. Methods ] Totally 78 strains of Staphylococcus aureus （SA） were isolated from various clinical specimens and 53 strains of SA were isolated from hospital environment in the same time period in a secondary general hospital in Shanghai. MRSA was detected by cefoxitin disk diffusion test and polymerase chain reaction. The antimicrobial susceptibility of SA was tested by K-B disk diffusion test against 15 antibiotics agents. Results ] Among the 131 strains, the proportion of MRSA was 55.73% （73/131）; the proportion of MRSA in the clinical strains and the environmental strains were 52.56% and 60.38% respectively （P〉 0.05）. The clinical MRSA strains were mainly distributed in sputum and wound secretion, and the environmental MRSA strains were mainly distributed in bedside tables, patient monitors, and the hands of medical staff. The MRSA-to-g-lactam antibiotic resistance rate was 100%; all of the MRSA samples were highly sensitive to glycopeptide drugs, linezolid, rifampin, and showed muhidrug resistance to other antibiotics. Conclusion ] MRSA is highly prevalent in hospital, and most MRSA strains are multi-drug resistant. Rational use of antibiotics and surveillance of MRSA nosocomial infection should be strengthened. Disinfection and quarantine for patients infected by MRSA should be performed in time.