金黄色葡萄球菌临床分离株耐药谱分析

目的了解临床分离金黄色葡萄球菌对常用抗菌药物的耐药情况及克林霉素诱导型耐药的发生率,为临床合理应用抗菌药物提供依据。方法应用TDR、Vitek2微生物分析系统及K-B法药敏试验对临床分离菌株进行鉴定和药物敏感性测定;头孢西丁纸片扩散法检测MRSA;D试验检测诱导型克林霉素耐药;Whonet5.4及SPSS13.0软件对结果进行统计分析。结果117株金黄色葡萄球菌主要来源于呼吸道(50株,42.7%)和分泌物(29株,24.8%)标本,有16种主要耐药谱型;同时对5种以上抗菌药物不敏感(包括耐药和中介)有93株(79.5%)。青霉素和氨苄西林耐药率最高,分别为95.7%和94.0%;替考拉宁、万古霉素和利奈唑烷的敏感率最高,均为100%。117株金葡菌中,MRSA共87株(74.4%),MSSA30株(25.6%);MRSA对13种抗菌药物的耐药率高于MSSA。对红霉素耐药而克林霉素敏感的15株金葡菌中,10株(66.7%)为诱导型克林霉素耐药。结论临床分离金黄色葡萄球菌对常用抗菌药物多重耐药;临床微生物室开展D试验检测葡萄球菌中红霉素对克林霉素的诱导耐药性可帮助临床医生正确选用抗菌药物。

Antimicrobial-resistant Profile of Staphylococcus aureus Isolated from Clinical Specimens

Objective To investigate the resistance to commonly used antimicrobial agents and the prevalence of inducible clindamycin resistance in clinical isolates of Staphylococcus aureus,and to provide guidance for the proper use of antibiotics.Methods Bacteria identification and susceptibility test were performed by TDR,vitek-2 system and K-B disk method,and MRSA was identified by cefoxitin disk diffusion method.The inducible resistance of erythromycin to clindamycin was checked by D-test according to the standards of CLSI(NCCLS).The statistical analysis was performed by Whonet 5.4 and SPSS 13.0 software.Results Totally 117 strains were isolated from respiratory tract(50,42.7%)and secretion specimens(29,24.8%)and exhibited chiefly 16 profiles.93 isolates were nonsusceptible to more than five antimicrobial agents.Resistant rate to penicillin and ampicillin accounted for 95.7%and 94.0% respectively.Sensitive rate to teicoplanin,vancomycin and linezolid accounted for 100.0%.Methicillin resistant Staphylococcus aureus(MRSA) and methicillin sensitive Staphylococcus aureus(MSSA) were 87(74.4%) and 30(25.6%) respectively.The resistant rate of MRSA to 13 antibiotics was higher than MSSA.Of the 15 isolates resistant to erythromycin but susceptible to clindamycin,10(66.7%) showed inducible resistance to clindamycin.Conclusions Staphylococcus aureus is multiple resistant to commonly used antimicrobial agents.The inducible resistance of erythromycin to clindamycin in Staphylococcus should be checked by D-test in clinical microbiology laboratory in order to help physicians to select antimicrobial agents correctly.