结核病患者医院获得性金黄色葡萄球菌感染110例耐药性分析

目的分析结核痛患者医院获得性感染金黄色葡萄球菌（Staphylococcus aureus）的耐药情况。方法收集我院住院肺结核、结核性胸膜炎、结核性脑膜炎患者痰、胸水、脓汁、血液标本110例，进行培养、鉴定，以Kirby—Baure（K—B）法进行药敏试验，依据美国临床实验室标准化委员会（CLSI）2007版标准进行判断，以头孢西丁（30μg／片）纸片扩散法筛选耐甲氧西林金黄色葡萄球菌（methicillin resistant Staphyloococcus sureus MRSA）。结果110例金黄色葡萄球菌中，耐甲氧西林金黄色葡萄球菌（MRSA）76株，检出率69．09％。所有分离菌株对万古霉索敏感、对青霉素耐药；阿奇霉素、红霉素、头孢西丁、克林霉素、妥布霉素、左氧氟沙星、庆大霉素、利福平、四环素、复方新诺明、阿米卡星、米诺环素的耐药率分别为85．71％、82．69％、69．09％、68．57％、65．63％、61．54％、56．00％、55．10％、48．78％、47．06％、35．90％、25．81％。耐甲氧西林金黄色葡萄球菌（MRSA）株耐药率明显高于甲氧西林敏感的金黄色葡萄球菌（MSSA），差异有统计学意义。结论医院获得性感染金黄色葡萄球菌不容忽视，尤其是MRSA株，可同时对多种抗菌药物耐药，提示临床应该规范合理使用抗生素，加强耐药监测，发现MRSA株及时隔离，控制医源性感染。

The drug resistance of hospital acquired infection of Staphylococcus aureus in 110 patients with tubereulosis

Objective The main purpose of this research to analyze the drug resistance of TB patients infected with Staphylococcus aureus. The main method is to first collect sputum, pleural fluid, pus, blood samples about 110 cases were from patients suffered from tuberculosis, tuberculous pleurisy, tuberculous meningitis in our hospital, and then to culture and identify these samples. Finally, we conducted a drug sensitive test based on Kirby - Baure （KB） method, and came to the results according to the judgment criteria of Commission on Clinical laboratory Standards （CLSI） 2007, and finally the methicillin - resistant Staphylococcus aureas was sifted through the method of cefoxitin （30ug/siice） disk diffusion. The result showed that methicillin - resistant Staphylococcus aureus （MRSA） was 76 strains among 110 cases of Staphylococcus anreus, the detective rate accounted for 69.09% . All separated strains were sensitive to vancomycin, relatively, resistant to penicillin. The resistant rate of azithromyein, erythromycin, cefoxitin, elindamycin, tobramyein, levofloxacin, gentamlcin, rifampin, tetracycline, cotrimoxazole, amikacin, minocycline is respectively： 85.71%, 82.69%, 69.09%, 68.57%, 65.63%, 61.54%, 56.00%, 55.10%, 48.78%, 47.06 %, 35.90%, and 25.81% . The resistance rate of methicillin - resistant Staphylococcus anreus （MRSA） strains was obviously higher than that of methiciUin - sensitive Staphylococcus aureus （MSSA）, and the difference was statistically significant. In conclusion, we should not ignore those acquired infectious Staphylococcus aureus, especially MRSA strains, which can generate drug resistance to a variety of antimicrobial. The result shows that antibiotics in clinical use should be reasonable, resistance monitoring should be strengthened. Once MRSA stains are found, the patient should be isolated immediately so that we can control iatrogenic infection.