儿童社区获得性肺炎耐甲氧西林金黄色葡萄球菌的耐药性及定植危险因素分析

目的:探讨我院儿童社区获得性肺炎(CAP)耐甲氧西林金黄色葡萄球菌(MRSA)的耐药性,分析呼吸道定植危险因素。方法:采用回顾性研究方法,从2012-2014年在我院住院的CAP患儿中选取痰培养检出金黄色葡萄球菌(SA)的患儿692例,根据药敏试验结果将692株SA分为社区获得性甲氧西林敏感金黄色葡萄球菌(CA-MSSA)和社区获得性MRSA(CA-MRSA)两组,检测分析SA对常用抗菌药物的耐药率,并采用Logistic回归分析方法从性别、年龄、发病地点、抗菌药物使用时间等方面分析MRSA呼吸道定植的危险因素。结果:2012-2014年我院SA检出率为7.23% (692/9569), 692株SA中MRSA 226株(32.66%)。CA-MSSA对红霉素、阿奇霉素耐药率较高;CA-MRSA对青霉素类、头孢菌素类基本耐药,对亚胺培南、阿奇霉素及克林霉素部分耐药,对利福平、复方磺胺甲唑及左氧氟沙星的耐药率较低,对万古霉素未产生耐药。CA-MRSA对常用抗菌药物的耐药率均高于CA-MSSA(P均<0.05)。低龄(<3岁)、在农村发病、长时间使用抗生素(≥7 d) 是CA-MRSA定植的危险因素。结论:基层医疗机构规范使用抗生素对控制CA-MRSA定植与感染有重要意义。我们在临床工作中应加强具有高危因素患儿的管理,及时完善细菌学检查,合理选用抗菌药物。

Analysis of Drug Resistance and Risk Factors of Methicillin-Resistant Staphylococcus Aureus Colonization in Children with Community-Acquired Pneumonia

Objective: To investigate the drug resistance rate of methicillin-resistant Staphylococcus aureu (MRSA) and the risk factors of airway colonization in the children with community-acquired pneumonia. Methods: A total of 692 children with community-acquired pneumonia who cultured methicillin resistant Staphylococcus aureu (CA-MRSA) were selected from 2012 to 2014. All children were divided into community-acquired methicillin-sensitive Staphylococcus aureu (CA-MSSA) group and community-acquired MRSA (CA-MRSA) group after admission in patients with sputum bacteriological isolation and culture. The drug resistance rates of all the bacteria were detected. Logistic regression analysis was used to analyze the gender, age, place of occurrence and length of antibiotics use and find the risk factors of airway colonization in MRSA. Results: 2012 to 2014, 9, 569 specimens were detected, 692 strains of Staphylococcus aureus were separated, accounted for 7.23%. Two hundreds and twenty six strains of MRSA were isolated from Staphylococcus aureus, accounted for 32.66%. CA-MRSA had high resistance to erythromycin and azithromycin, resistance to penicillinsand cephalosporins, partial resistance to imipenem, azithromycin and clindamycin, and lower resistance to rifampicin, sulfamethoxazole and levofloxacin, but they were all sensitive to vancomycin. The drug resistant rate of CA-MRSA to commonly used antibiotics was higher than those of CA-MSSA. The age (<3 years), living in rural areas, length of antibiotic therapy (signo maior ou igual que 7 d) were risk factors for CA-MRSA colonization. Conclusion: Regulate the use of antibiotics in primary hospital can control CA-MRSA colonization and infection effectively. We should strengthen the management of high risk infants, and regulate the use of antibiotics.