摘要
目的探讨重症监护病房(ICU)耐甲氧西林金黄色葡萄球菌(MRSA)的分布特点及耐药性变迁。方法收集2016~2018年某三甲医院ICU病区送检标本金黄色葡萄球菌的培养结果和药敏结果等相关资料,回顾性分析MRSA菌株的分布特点及其耐药性变迁情况。结果3年间,ICU病房共检出392株金黄色葡萄球菌,MRSA检出率为66.6%。MRSA检出率随着患者年龄的增大呈总体上升趋势,男性患者的检出率略高于女性患者,每年夏季MRSA检出率出现高峰,各类标本中痰液的MRSA检出率最高,血液次之。3年间,MRSA对利福平和氨基糖苷类抗生素如庆大霉素、妥布霉素等的耐药率下降,对克林霉素和红霉素的耐药率逐渐增高,对阿莫西林/克拉维酸钾、环丙沙星、四环素的耐药率均高于90%。结论ICU病房的MRSA检出率高,临床医生需对MRSA感染保持高度重视,选择适当的早期抗菌治疗方案;在院感防控方面,应结合科室自身特点,制定强调环境清洁的临床实践规程,同时对细菌耐药性进行长期的动态监测,积极采取多种措施控制抗菌药物的不规范使用,降低MRSA感染风险。
Objective To investigate the distribution characteristics and drug resistance evolution of methicillin-resistant Staphylococcus aureus(MRSA)in intensive care unit(ICU).Methods The relevant data such as the results of bacterial culture and drug sensitivity of Staphylococcus aureus in samples collected from an ICU ward in a class A tertiary hospital from 2016 to 2018.The distribution characteristics and drug resistance evolution of MRSA strains were retrospectively analyzed.Results A total of 392 Staphylococcus aureus strains were detected in the ICU ward in the three years,with a detection rate of MRSA of 66.6%.The detection rate of MRSA increased with patients′age,showing an overall upward trend.The detection rate of male patients was slightly higheRthan that of female patients.The MRSA detection rate reached a peak in summeRannually.Among various kinds of samples,the detection rate of MRSA was highest in sputum,followed by blood.During the three years,the drug resistance rates of MRSA to rifampicin and aminoglycoside antibiotics such as gentamicin and tobramycin decreased,the resistance rates to clindamycin and erythromycin increased gradually,and the resistance rates to amoxicillin/clavulanate potassium,ciprofloxacin and tetracycline were all higheRthan 90%.Conclusion The detection rate of MRSA in ICU ward is high.Clinical doctors should attach great importance to MRSA infection,and choose appropriate antibiotic treatment regimens in early stage.In terms of nosocomial infection prevention and control,clinical practice procedures that highlight environmental cleanliness should be formulated in accordance with the characteristics of the department itself;in addition,long-term dynamic monitoring of bacterial resistance should be performed,and various measures should be proactively taken to control the irregulaRuse of antibacterial agents so as to reduce the risk of MRSA infection.
作者
唐克文
李从荣
汪倩钰
TANG Ke-wen;LI Cong-rong;WANG Qian-yu(Department of Clinical Laboratory,Renmin Hospital of Wuhan University People′s Hospitial,Wuhan 430060,China)
出处
《广西医学》
CAS
2020年第3期315-318,333,共5页
Guangxi Medical Journal
基金
国家自然科学基金(81760544)
广西医科大学青年科学基金项目(GXMUYSF201720).
关键词
重症监护病房
耐甲氧西林金黄色葡萄球菌
耐药性变迁
分布特点
院感
Intensive care unit
Methicillin-resistant Staphylococcus aureus
Drug resistance evolution
Distribution characteristics
Nosocomial infection
