社区医院与三级综合医院MSSA与MRSA的耐药率比较

目的 统计分析社区医院与三级综合医院MSSA与MRSA构成比及耐药率,为葡萄球菌感染合理用药提供依据.方法 采用纸片扩散法,按照CLSI标准判断金黄色葡萄球菌(SA)对抗菌剂的耐药性并统计MSSA及MRSA耐药情况.结果 社区医院检出74株金黄色葡萄球菌中有35株为MRSA,构成比47.3%,三级综合医院检出301株金黄色葡萄球菌中有189株为MRSA,构成比为62.8%.药敏结果显示,甲氧西林敏感的金黄色葡萄球菌(MSSA)门诊的耐药率综合医院均比社区医院高,尤其是庆大霉素和红霉素耐药率分别为35.5%与5.9%;80.6%与35.3%.MSSA住院的耐药率红霉素、克林霉素及复方新诺明三类药物社区医院高于综合医院,尤其是克林霉素耐药率为68.2%与43.2%.耐甲氧西林金黄色葡萄球菌(MRSA)综合医院与社区医院住院患者比较庆大霉素、克林霉素耐药率都增高,分别是88.0%与74.2%;92.7%与77.4%.两院均未检出对万古霉素耐药的菌株.结论 三级综合医院MRSA占SA中的比例明显高于社区医院,MRSA耐药率明显高于MSSA.目前社区与三级综合医院金黄色葡萄球菌耐药严重,临床应根据药敏结果合理使用抗菌剂.

Comparison of the drug resistance of MSSA and MRAS between community hospital and three-level general hospital

Objective To analyze the constituent ratio and drug resistance of methicillin sensitive Staphylococcus aureus(MSSA) and methicillin sensitive Staphylococcus aureus(MRSA) in community hospital and three-level general hospital for rational usage of antibiotics.Methods Drug resistance of Staphylococcus aureus(SA) was detected by K-B method and assessed according to CLSI standards.Drug resistance of MSSA and MRSA were respectively analyzed.Results The constituent ratios of MRSA among SA in community hospital and three-level general hospital were 47.3%(35/74) and 62.8%(189/301).Drug resistance rates of MSSA,isolated from out-patients samples,in three-level general hospital were higher than those in community hospital.Drug resistance rates of MSSA to gentamicin and erythromycin were 35.5% and 80.6% in three-level general hospital and 5.9% and 35.3% in community hospital.Drug resistance rates of MSSA,isolated from in-patients samples,to erythromycin,clindamycin and trimethoprim-sulfamethoxazole in community hospital were higher than those in three-level general hospital,especially to clindamycin were 68.2% and 43.2% respectively.Drug resistance rates of MRSA to gentamicin and clindamycin were 88.0% and 92.7% in general hospital and 74.2% and 77.4% in community hospital.No vancomycin resistant strain was isolated from general or community hospitals.Conclusion The constituent ratio of MRAS among AS in three-level general hospital might be higher than that in community hospital,and the resistance rate of MRAS in the former also might be higher than in the latter.Drug resistance of SA might be serious in both general hospital and community hospital,and antibiotics should be rationally used according to the results of drug susceptibility test.