耐甲氧西林金黄色葡萄球菌感染的流行病学调查、耐药性监测与预后因素分析

肥目的探讨耐甲氧西林金黄色葡萄球菌（MRSA）的流行分布和多药耐药趋势及预后相关因素，采取有效的医院管理措施。方法采用回顾性调查方法，VITEK-60全自动微生物分析系统进行细菌鉴定，K—B法做体外药敏试验，采用Logistic回归分析危险因素。结果445株金黄色葡萄球菌中MRSA检出率为46．96，其分离率有逐年增长的趋势（P〈0．05）；MR—SA检出率以老年痛科最高，其次重症监护病房，神经外科；药敏结果显示MRSA对万古霉素、利奈唑胺、替考拉宁全部敏感之外，对另外10种抗生素均不同程度耐药；多器官功能衰竭、住院时间长、长期大剂量使用广谱抗菌药物、机械通气、高龄、MRSA未清除、近期手术史是MRSA的独立危险因素，万古霉素、替考拉宁、利奈唑胺是MRSA感染的保护性因素。结论金黄色葡萄球菌耐药严重，MRSA的高检出率给临床治疗及控制医院感染带来较大困难；糖肽类抗菌药物可作为多药耐药金黄色葡萄球菌感染的首选抗菌药；MRSA感染的危险因素较多，尽早进行痛原学监测，及时发现、隔离和治疗对疾病预后有重要影响。

Epidemiological survey, drug resistance monitoring and prognostic factors analysis of methicillin - resistant Staphylococcus aureus infection

Objective To investigate the distribution of methicillin- resistant Staphylococcus anreus（MRSA） epidemic and multidrug resistance trends and prognostic factors, and effective hospital management measures. Methods A retrospective survey methods by VITEK 60 automated microbial analysis system for bacterial identification, the K- B method to do the in vitrosusceptibility testing, using logistic regression analysis risk factors. 445 Staphylococcus aureusMRSA detection rate of 46.96, the separation rate year by year growth trend （ P 〈 0.05 ） ; of MRSAdetection rates to the Department of Geriatrics, the highest, followed by intensive care unit, neurosurgery; susceptibility, of MRSA to vancomycin, linezolid, teicoplanin all sensitive, another10 kinds of antibiotics are varying degrees of resistance; multiple organ failure, long hospital stay, long - term highdose use of broad spectrum antimicrobial agents, mechanical ventilation, senior citizens, MRSA is not clear, recent surgery, is an independent risk factor of MRSA, vancomycin, teicoplanin, linezolid protective factors for MRSA infections. Conclusions Staphylococcus anreus resistant severe, the high detection rate of MRSA to clinical treatment and control of hospital infections bring greater difficulties; glyeopeptide class of antibacterialdrugs can be used as the preferred antimicrobial agents multidrug - resistant Staphylococcus aureus infection ; of MRSA the more risk factors for infection as soon as possible pathogen monitoring, timely detection, isolation and treatment of dis- ease prognosis.