耐甲氧西林金黄色葡萄球菌的药敏性变化分析

目的 了解耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)的药敏性变化，为临床抗感染治疗和控制医院感染提供分析数据。 方法 选取2014年1月—2015年10月接收的痰液、分泌物、脓液、全血、胸水、腹水、前列腺液、尿液标本共128例，均检出金黄色葡萄球菌。检测不同标本类型分离的金黄色葡萄球菌对抗菌药物的敏感率，比较甲氧西林敏感金黄色葡萄球菌(methicillin sensitive staphylococcus aureus,MSSA)和MRSA对抗菌药物的敏感率。另外2011—2014年每年选取30株MRSA，检测万古霉素、替考拉宁、利奈唑胺对其的最小抑菌浓度情况。 结果 128株金黄色葡萄球菌中检出MRSA 44株，MRSA阳性率为34.38%；住院MRSA阳性率为40.66%(37/91)，高于门诊MRSA阳性率18.92%(7/37)，差异有统计学意义(χ2=4.950，P＜0.05)。痰液的MRSA检出率最高(51.11%)，分泌物的MRSA检出率最低(20.51%)；不同标本的MRSA检出率的差异有统计学意义(χ2=12.301，P＜0.05)。MSSA和MRSA对奎奴普汀/达福普汀、替考拉宁、万古霉素、利福平、利奈唑胺、替加环素、呋喃妥因的敏感率均为100.00%；MSSA对苯唑西林、左氧氟沙星、红霉素、克林霉素、四环素、环丙沙星、磺胺异噁唑/甲氧苄啶、莫西沙星的敏感率均显著高于MRSA(P均＜0.01)。万古霉素、替考拉宁对MRSA的MIC呈现逐年上升的趋势，而利奈唑胺对MRSA的MIC基本不变。2014年万古霉素、替考拉宁对MRSA的MIC均显著高于2011年(t=36.242、14.394，P均＜0.01)。 结论 不同标本类型分离的金黄色葡萄球菌有不同的药敏性和MRSA检出率，临床上应注意监测MRSA对糖肽类抗菌药物的MIC。 

Analysis of drug sensitivity of methicillin-resistant Staphylococcus aureus

Objective To learn the drug sensitivity of methicillin-resistant Staphylococcus aureus(MRSA)in our hospital,and provide analysis data for clinical anti-infection treatment and the control of hospital infection. Methods From January,2014 to October,2015,128 cases of sputum,secretion,pus,blood,hydrothorax,ascites,prostatic fluid and urine samples were received,Staphylococcus aureus were detected in all of the specimens.The sensitivity of Staphylococcus aureus to antimicrobial agents was detected,and the sensitivity of MSSA and Methicillin sensitive Staphylococcus aureus(MSSA) to the antimicrobial susceptibility was compared.From 2011 to 2014,Minimum inhibitory concentration(MIC) of 30 strains of MRSA was detected. Results Forty-four strains of MRSA were detected in 128 strains of Staphylococcus aureus,MRSA positive rate was 34.38%;MRSA detection rate of sputum was highest,51.11%;the lowest MRSA detection rate was 20.51% from secretions;there were statistically significant differences in MRSA detection rates of different samples(χ2=12.301,P<0.05).The sensitivity rates of MSSA and MRSA to Quinupristin/dalfopristin,teicoplanin,vancomycin,rifampin,linezolid,tigecycline and nitrofurantoin were 100.00%;The sensitivity rates of MSSA to Oxacillin,Levofloxacin,erythromycin,clindamycin,tetracycline,ciprofloxacin,sulfamethoxazole/trimethoprim and moxifloxacin were significantly higher than that of MRSA,the differences were statistically significant(P<0.01).MIC of Vancomycin and teicoplanin to MRSA showed increasing trend,and MIC of linezolid against MRSA remained unchanged.In 2014,MIC of Vancomycin and teicoplanin to MRSA were significantly higher than in 2011(t=36.242,14.394,P<0.01). Conclusion Staphylococcus aureus isolated from different types of samples have different drug sensitivity and MRSA detection rate,monitoring MIC of glycopeptide antimicrobial agents to MRSA should be pay attention in clinical treatment.