急诊重症监护病房金黄色葡萄球菌耐药性分析

目的:研究急诊重症监护病房(ICU)2009—2010年临床分离的金黄色葡萄球菌(金葡菌)对各类抗菌药物的耐药性分析。方法:按统一的材料、方法和判断标准美国临床实验室标准化协会(CLSI)2009年版]对急诊ICU2009年1月至2010年12月分离的117株金葡菌行耐药性监测,并对下呼吸道感染者的临床资料行回顾性分析。结果:117株金葡菌中耐甲氧西林金葡菌(MRSA)占85.5%,甲氧西林敏感金葡菌(MSSA)为14.5%;随着年龄的增加,MRSA感染者增多;MRSA对喹诺酮、红霉素、四环素的耐药率较高,对万古霉素、替考拉宁、利奈唑胺和达福普汀-奎奴普丁的敏感率仍保持100%;未发现万古霉素中介株(VISA)和耐药株(VRSA);急性生理学及慢性健康状况评分Ⅱ(APACHⅡ)评分、高龄(>70岁)、住院天数>20 d、清蛋白水平、慢性肺病、机械通气、意识障碍、长期住护理院是下呼吸道感染MRSA的危险因素,清蛋白、高龄和住护理院是其独立危险因素。结论:MRSA的耐药性高,应加强其耐药性监测,并根据分离株的耐药特点规范抗菌药物的应用。

Antibiotic resistance of Staphylococcus aureus strains isolatated from intensive care unit

Objective To investigate the antibiotic resistance of Staphylococcus aureus strains isolated from intensive care unit(ICU) during 2009 and 2010.Methods Susceptibility test was performed in accordance with an unified protocol.Results were analyzed according to Clinical and Laboratory Standards Institute(CLSI) 2008 interpretation criteria,and the clinical data of patients with lower respiratory tract infection were analyzed retrospectively.Results Of the 117 clinical isolates of Staphylococcus aureus,methicillin-resistant Staphylococcus aureus(MRSA) accounted for 85.5%,and 14.5% were methicillin-sensitive Staphylococcus aureus(MSSA).The MRSA rate increased with the increase of age.The MRSA strains showed a higher resistance to fluoroquinolones,erythromycin,tetracycline,but were still with a 100% susceptibility to vancomycin,teicoplanin,linezolid and quinupristin-dalfopristin.No vancomycin-intermediate Staphylococcus aureus(VISA) or vancomycin resistant Staphyloccous aureus(VRSA) strain was found.The risk factors of lower respiratory tract infection were score of acute physiology and chronic health evaluationⅡ(APACHⅡ),advanced age(>70 years old),hospital stay >20 d,serum albumin level,chronic pulmonary disease,mechanical ventilation,consciousness disturbance and long stay in nursing home.Serum albumin level,advanced age and long stay in nursing home were independent risk factors.Conclusions Clinical isolates of MRSA are mostly multiple-drug resistant.Monitoring of drug resistance should be strengthened,and the antimicrobial therapy should be defined on the basis of resistant pattern.