重症监护病房（ICU）患者感染耐甲氧西林金黄色葡萄球菌（MRSA）的鉴定与特征

摘要:目的　监测ICU感染耐甲氧西林金黄色葡萄球菌（Methicillin Resistant Staph. Aureus，MRSA）的分布及耐药特征，为临床防控MRSA提供对策。方法　采集ICU院内感染患者感染标本，VITEK 2 COMPACT 进行病原菌鉴定及药敏试验，PCR检测mecA基因。结果　2011年1月-2013年12月期间，采集ICU患者714份感染标本，金黄色葡萄球菌检出448株，分离率为62.3%（448/714）；MRAS检出322株，检出率为71.9%，以痰标本分离率最高（80.1%）；MRSA对庆大霉素、红霉素及喹诺酮类抗菌药物耐药率均超过50%，未出现对利奈唑胺、万古霉素和替考拉宁耐药的金黄色葡萄球菌。mecA基因检出率为100.0%。结论　ICU患者感染金黄色葡萄球菌检出率高，MRSA表现多重耐药，应及时监控ICU患者感染MRSA分布及耐药特点，为促进感染患者的康复和预后提供参考。

Identification and characterization of methicillin-resistant staphylococcus aureus isolates from patients in ICU

Abstract: Objective The aim of this study was to investigate the characteristics of antibacterial resistance among methicillin resistant Staph. aureus (MRSA) isolates from ICU, in order to guide the rational use of antibiotics. Methods ID identification cards (France's BioMerieux) were used to identify bacterial strains. ATB was used for drug sensitivity test. Kirby-Bauer method with cefoxitin was used to corroborate the MRSA strains, while mecA genes were detected by PCR. Results Four hundred and forty-eight (62.3%) strains of Staph. aureus were isolated from 714 specimens between 2011 and 2013. Three hundred and twenty-two strains were confirmed to be MRSA which harbored mecA genes in all of the isolates. The main source of MRSA was from sputum specimens (80.1%). The resistance rates of MRSA isolates were higher than the rates of non MRSA, and were over 50% against gentamycin, rifampin, ciprofloxacin, amoxicillin, levofloxacin. However, the resistant strains against vancomycin, linezolid, teicoplanin were not detected in all isolates. Conclusion High detection rate of MRSA infection was reported in ICU patients and all MRSA isolates showed multiple resistances to most of the antimicrobial agents. It played a very important role to screen the patients with MRSA for directing the clinical treatment.