2016~2019年陕西省榆林市细菌耐药监测网成员单位金黄色葡萄球菌的临床分布与耐药性变迁

目的　分析 2016-2019年陕西省榆林市细菌耐药监测网成员单位金黄色葡萄球菌临床分布与耐药性变迁，为金黄色葡萄球菌感染合理用药提供依据。方法　收集 2016~2019年陕西省榆林市细菌耐药监测网成员单位（榆林市一院、榆林市二院、府谷县人民医院、神木市医院、榆林星元医院、定边县医院、靖边县医院、绥德县医院共 8家医院）常规分离、培养的 1 296株金黄色葡萄球菌的监测数据，所有检测按 CLSI2019规定的标准执行。结果　1 296株金黄色葡萄球菌（ SAU）从科室分布看，主要分布在外科（ 19.3%）、儿科（ 13.1%）、重症医学科（ 8.7%）和骨科（ 8.2%）；从标本类型分布看，主要分布在痰液（ 23.8%）、分泌物（ 22.7%）、脓液（ 13.7%）和伤口（ 11.9%）。在 1 296株 SAU中甲氧西林耐药金黄色葡萄球菌（ MRSA）占比为 20.2%；MRSA比甲氧西林敏感金黄色葡萄球菌（ MSSA）抗生素耐药率明显偏高，两组之间的差异有统计学意义（ P<0.01）；四年内对青霉素耐药率都在 93.3%以上；对红霉素耐药率都在 62.7%以上；对克林霉素耐药率都在 26.8%以上；对复方新诺明耐药率都在 25%以下，且有连续下降的趋势；对氯霉素、利福平、环丙沙星、莫西沙星和庆大霉素的耐药性都在 15%以下；对利奈唑胺、万古霉素、替考拉宁和呋喃妥因四类药物尚未产生耐药性。结论　利奈唑胺、万古霉素、替考拉宁及呋喃妥因均可作为 SAU感染的经验用药，除此外其他抗生素选用建议要参照药敏试验进行，以此来促进金黄色葡萄球菌感染的精准治疗并延缓耐药菌株的出现。

Clinical Distribution and Drug Resistance Changes of Staphylococcus Aureus,A Member of the Bacterial Resistance Monitoring Network in Yulin,Shaanxi Province from 2016 to 2019

Objective To analyse the clinical distribution and drug resistance changes of Staphylococcus aureus in member units of the bacterial resistance monitoring network in Yulin City of Shaanxi Province from 2016 to 2019 in order to provide a basis for the rational use of Staphylococcus aureus infection.Methods The surveillance data of 1296 strains of Staphylococcus aureus routinely isolated and cultured were collected from the member units of the bacterial resistance monitoring network of Yulin City of Shaanxi Province(including the First Hospital of Yulin City,the Second Hospital of Yulin City,the Fugu County People’s Hospital,the Shenmu City Hospital,the Yulin Xingyuan Hospital,the Dingbian County Hospital,the Jingbian County Hospital,and the Suide County Hospital,a total of 8 hospitals)from 2016 to 2019,and all testswere performed according to the standards stipulated by CLSI2019.Results In terms of department distribution,1296 strains of Staphylococcus aureus(SAU)were mainly distributed in surgery(19.3%),pediatrics(13.1%),critical care(8.7%)and orthopedics(8.2%).The specimens were mainly distributed in sputum(23.8%),secretions(22.7%),pus(13.7%)and wounds(11.9%).In 1296 SAU strains,methicillin resistant golden grape bulb(MRSA)accounted for 20.2%.The antibiotic resistance rate of MRSA was significantly higher than that of methicillin sensitive golden grape ball(MSSA),and the difference between the two groups was statistically significant(P<0.01).The drug resistance rate of penicillin in four years was above 93.3%.The rate of erythromycin resistance was above 62.7%.The drug resistance rate of clindamycin was above 26.8%.The drug resistance rate of cotrimoxazole was under 25%and showed a trend of continuous decline.Resistance to chloramphenicol,rifampin,ciprofloxacin,moxifloxacin and gentamicin were all below 15%.Resistance to linazolamide,vancomycin,tekoranin and furantoin has not yet been developed.Conclusion Linezolid,vancomycin,teicoplanin,and nitrofurantoin can be used as empirical drugs for SAU infection.In addition to other antibiotics,it is recommended to refer to the drug susceptibility test to promote the accurate treatment of S.aureus infection and delay the emergence of drug-resistant strains.