骨科感染患者革兰阳性球菌的耐药监测研究

目的监测骨科感染患者中革兰阳性球菌的分布特点及对抗菌药物的敏感性。方法收集2011~2013年该院骨科感染患者的663株革兰阳性球菌,采用最小抑菌浓度(MIC)的微量稀释法和美国临床和实验室标准协会判断标准进行药敏结果分析。结果骨科革兰阳性球菌感染以金黄色葡萄球菌检出率最高,其次是表皮葡萄球菌。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林表皮葡萄球菌(MRSE)主要分布在创伤骨科和手外科两个病区。MRSA和MRSE的检出率分别为34.2%和73.0%。MRSE对抗菌药物的敏感率较MRSA高。粪肠球菌和屎肠球菌中耐万古霉素肠球菌(VRE)检出率分别为0.0%和5.9%,未发现对利奈唑胺耐药的肠球菌。结论金黄色葡萄球菌为骨科感染谱中最常见的革兰阳性球菌。骨科医师应在使用抗菌药物前进行细菌培养,结合药敏试验,合理使用抗菌药物,减缓细菌耐药性的产生。

Drug resistance surveillance of Gram-positive cocci strains isolates from orthopedic patients with infections

Objective To investigate the Gram-positive cocci distribution characteristics and their susceptibili-ty to antibacterial drugs in the orthopedic patients with infections.Methods 663 strains of Gram-positive cocci were collected from the orthopedic patients with infections in our hospital from 201 1 to 2013.The antimicrobial suscepti-bility testing was carried out by adopting the minimum inhibitory concentration (MIC)method.The data were ana-lyzed according to the criteria of the Clinical and Laboratory Standards Institute.Results Staphylococcus aureus had the highest detection rate in the orthopedic patients with Gram-positive cocci infection,and followed by Staphylococ-cus epidemidis.The strains of methicillin resistant Staphylococcusaureus(MRSA)and methicillin resistant Staphylo-coccus epidemidis(MRSE)mainly distributed in the trauma orthopedic wards and hand surgery wards.The detection rates of MRSA and MRSE were 34.2% and 73.0% respectively.The susceptibility of MRSE strains to antimicrobial agents was higher than that of MRSA.The detection rates of vancomycin resistant enterococcal(VRE)in Enterococ-cus faecalis and Enterococcus faecium were 0.0% and 5.9% respectively.Linezolid resistant Enterococcus was not found.Conclusion Staphylococcus aureus is the most common Gram-positive cocci in the orthopedic infection spec-trum.The orthopedic doctors should conduct the bacterial culture before using the antibacterial drugs and rationally use the antibacterial drugs by combining with the drug susceptibility test results in order to retard the generation of bacterial drug resistance.