显色培养基检测医务人员手和鼻咽携带耐甲氧西林金黄色葡萄球菌方法的应用评价

目的：通过对本院医生、护士及护理员的手及鼻咽前庭进行耐甲氧西林金黄色葡萄球菌（MRSA）检出情况的分析，比较两种检验方法MRSA的检出效果。方法将医护人员的678例手标本及179例鼻咽前庭标本分别用两种检验方法进行MRSA鉴定，一种将标本用血平板分离培养初筛后，再用全自动微生物鉴定仪进行菌种鉴定，同时用头孢西丁（30μg/片）和苯唑西林（1μg/片）纸片扩散法按2010年美国CLSI抗菌药物敏感试验标准进行药物敏感试验鉴定MRSA，此传统检测方法为本实验的参考方法，结果准确可靠，另一种将标本直接接种于MRSA选择性显色培养基上，根据判定说明书观察在培养基上金黄色葡萄球菌的生长情况鉴定MRSA，此为快速检测方法，并进行两种方法MRSA检出效果的比较。结果传统检测方法检出手标本有5株MRSA，44株甲氧西林敏感金黄色葡萄球菌（MSSA），鼻咽前庭拭子标本有3株MRSA，22株MSSA；快速检测方法检出手标本有6株MRSA，43株MSSA，鼻咽前庭拭子标本有3株MRSA，22株MSSA。结论采用MRSA选择性显色培养基方法与传统检测方法比较，手标本检出MRSA的总符合率为95.9%，鼻咽前庭标本检出MRSA的总符合率为100%，两种检测方法对于MRSA及MSSA检出结果均无显著性差异（P〉0.05），由于其操作简便，特异性高，适合于在各级临床实验室广泛推广用于鉴定MRSA。

Evaluation of MRSA selective medium in detection of methicillin-resistant staphylococcus aureus from hands and nasal vestibular of the medical staffs

Objective To analysis the detection of methicillin-resistant Staphylococcus aureus （MRSA） from the hands and nasal vestibular of doctors, nurses and attendants, and compare the detection effect for MRSA of two kinds of test methods. Meth-ods A total of 678 hand specimens and 179 nasopharyngeal vestibular specimens of medical staffs were treated with two kinds of test methods for identification of MRSA. Firstly, we collected specimens with blood agar plates and then identified the strains by automatic microorganism instrument after screening. At the same time, the drug sensitivity tests with cefoxitin （30μg/） and oxacillin （1μg/） were performed by K-B disk diffusion method for identification of MRSA;meanwhile, all the specimens were directly inoc-ulated on MRSA selective chromogenic medium to identify MRSA. At last, the effects of two test methods for identification of MR-SA were compared. Results A total of 5 strains of MRSA and 44 strains of methicillin sensitive Staphylococcus aureus （MSSA） were detected in the hand specimens, also 3 strains of MRSA and 22 strains of MSSA were detected in the nasopharyngeal vestibu-lar specimens by using the traditional method;6 strains of MRSA and 43 strains of MSSA were detected in the hand specimens, 3 strains of MRSA and 22 strains of MSSA were detected in the nasopharyngeal vestibular specimens by using the rapid method. Conclusion Comparing with the traditional detection method, the total coincidence rate of the rapid method for MRSA identifica-tion was 95.9% in the hand specimens and 100% in the nasopharyngeal vestibular specimens. The detection results of two test methods for MRSA and MSSA showed no significant difference（P〉0.05）. Because of the simple operation and high specificity of the rapid method, it is suitable for popularization in clinical laboratory for identification of MRSA.