Single center study on clinical distribution and drug resistance analysis of Staphylococcus aureus
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摘要:目的
分析中国人民解放军海军军医大学第一附属医院(下称本院)2016—2020年金黄色葡萄球菌(SA)的临床分布特点及其对抗菌药物的耐药情况，为临床合理应用抗菌药物提供依据。
方法回顾性分析从本院2016年1月—2020年12月1 575例患者送检样本中分离到的SA菌株，采用WHONET 5.6软件和SPSS软件对菌株的科室分布、样本来源和耐药情况等进行统计学分析。
结果送检样本中共分离出1 784株SA, 其中耐甲氧西林金黄色葡萄球菌(MRSA)926株(占51.9%)。检出SA菌株最多的科室是烧伤科(15.5%), 其后依次是呼吸科(7.3%)和整形外科(5.9%); SA菌株主要来源于呼吸道样本(44.6%), 其后依次是分泌物(30.4%)和血液(5.6%)。2016—2020年, SA菌株对青霉素的耐药率>90%, 对红霉素和克林霉素的耐药率为44.1%~62.4%, 对四环素、环丙沙星、左氧氟沙星和莫西沙星的耐药率为29.2%~44.1%; MRSA菌株对常见抗菌药物的总体耐药率普遍高于SA菌株; 未发现对替加环素、利奈唑胺和万古霉素耐药的SA菌株。
结论本院SA和MRSA的检出率均较高，医务人员应定期监测SA的临床分布和耐药情况，加强抗菌药物的临床应用管理，做好医院感染防控措施。
Abstract:ObjectiveTo analyze the clinical distribution characteristics and drug-resistant condition of Staphylococcus aureus (SA) in the First Affiliated Hospital of Naval Medical University of the Chinese People′s Liberation Army (called our hospital in the following text) from 2016 to 2020, so as to provide a basis for rational clinical application of antibacterial agents.
MethodsSA strains isolated from samples of 1 575 patients in our hospital from January 2016 to December 2020 were retrospectively analyzed. WHONET 5.6 software and SPSS software were used to statistically analyze the department distribution, sample source and drug resistance of the strains.
ResultsA total of 1 784 strains were isolated from the samples, including 926 strains (51.9%) of methicillin resistant Staphylococcus aureus (MRSA). The highest detection rate of SA occurred in burn department (15.5%), followed by respiratory department (7.3%) and department of plastic surgery (5.9%). SA strains were mainly derived from respiratory tract samples (44.6%), followed by secretion (30.4%) and blood (5.6%). From year of 2016 to 2020, the resistance rate of SA to penicillin was more than 90%, resistance rates were more than 44.1% to 62.4%to erythromycin and clindamycin, and were more than 29.2% to 44.1%to tetracycline, ciprofloxacin, levofloxacin and moxifloxacin. The overall drug resistance rate of MRSA strains was generally higher than that of SA strains. No SA strains were found to be resistant to tigecycline, linezolid and vancomycin.
ConclusionThe detection rate of SA and MRSA in our hospital is high. Regular monitoring of their clinical distribution and drug resistance has high clinical value for the rational use of antibiotics and the prevention and control of nosocomial infection.
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表 1 2016—2020年SA对常见抗菌药物的耐药率
% 抗菌药物 总体 2016年 2017年 2018年 2019年 2020年 青霉素 93.3 94.4 94.5 92.4 94.4 90.6 苯唑西林 51.9 53.4 52.2 46.8 53.7 54.2 红霉素 58.7 58.4 61.7 53.4 62.4 57.4 克林霉素 53.0 44.1 56.9 49.2 59.0 54.8 庆大霉素 19.1 20.6 17.2 15.0 21.3 22.3 四环素 37.1 38.8 35.4 31.3 44.1 36.8 环丙沙星 38.5 40.9 39.5 31.6 41.9 39.4 左氧氟沙星 38.3 40.6 39.5 31.3 41.6 39.4 莫西沙星 35.5 36.9 35.2 29.2 39.0 38.4 利福平 4.1 7.2 4.5 3.9 4.5 0.3 替加环素 0 0 0 0 0 0 利奈唑胺 0 0 0 0 0 0 万古霉素 0 0 0 0 0 0 
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表 2 2016—2020年MRSA对常见抗菌药物的耐药率
% 抗菌药物 总体 2016年 2017年 2018年 2019年 2020年 青霉素 100.0 100.0 100.0 100.0 100.0 100.0 苯唑西林 100.0 100.0 100.0 100.0 100.0 100.0 红霉素 78.6 77.2 77.1 77.0 84.3 77.4 克林霉素 73.5 61.4 72.9 74.7 83.2 74.4 庆大霉素 33.0 33.9 27.1 29.8 38.7 36.9 四环素 56.8 57.9 55.5 52.2 67.0 50.6 环丙沙星 61.8 64.9 60.6 55.6 67.5 60.1 左氧氟沙星 61.6 64.3 60.6 55.6 67.0 60.1 莫西沙星 59.6 62.6 57.3 53.4 65.4 59.5 利福平 7.5 12.9 8.3 7.3 8.4 0 替加环素 0 0 0 0 0 0 利奈唑胺 0 0 0 0 0 0 万古霉素 0 0 0 0 0 0
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[1] 王大胜, 王大新, 耿平. 成人血流感染金黄色葡萄球菌的临床分布及耐药性分析[J]. 实用临床医药杂志, 2018, 22(1): 1-3. doi: 10.7619/jcmp.201801001 [2] 李敏燕, 王继红, 王吉刚, 等. 血液病住院患者血流感染病原菌分布及耐药性分析[J]. 临床军医杂志, 2021, 49(11): 1261-1263. https://www.cnki.com.cn/Article/CJFDTOTAL-JYGZ202111027.htm [3] CHEUNG G Y C, BAE J S, OTTO M. Pathogenicity and virulence of Staphylococcus aureus[J]. Virulence, 2021, 12(1): 547-569. doi: 10.1080/21505594.2021.1878688
[4] 尚红, 王毓三, 申子瑜. 全国临床检验操作规程[M]. 4版. 北京: 人民卫生出版社, 2015: 120-123. [5] Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing[M]. 29th ed. Wayne, Pennsylvania: Clinical and Laboratory Standards Institute, 2019: 58-66.
[6] SAKR A, BRÉGEON F, MÈGE J L, et al. Staphylococcus aureus nasal colonization: an update on mechanisms, epidemiology, risk factors, and subsequent infections[J]. Front Microbiol, 2018, 9: 2419. doi: 10.3389/fmicb.2018.02419
[7] 王红, 郁洁, 王博, 等. 住院新生儿鼻腔和体表定植金黄色葡萄球菌的分子特征及耐药性[J]. 中国循证儿科杂志, 2021, 16(5): 379-383. doi: 10.3969/j.issn.1673-5501.2021.05.010 [8] 武杰, 薛丽伟, 赵建平. 金黄色葡萄球菌血流感染111例的临床特征和预后[J]. 中国感染与化疗杂志, 2021, 21(3): 264-270. https://www.cnki.com.cn/Article/CJFDTOTAL-KGHL202103004.htm [9] HSU Y Y, WU D, HUNG C C, et al. Methicillin-resistant Staphylococcus aureus nasal colonization among HIV-infected patients in Taiwan: prevalence, molecular characteristics and associated factors with nasal carriage[J]. BMC Infect Dis, 2020, 20(1): 254. doi: 10.1186/s12879-020-04979-8
[10] 刘云, 黄晓春, 马炜, 等. 烧伤患者院内感染病原菌分布及耐药性分析[J]. 第二军医大学学报, 2019, 40(7): 710-715. https://www.cnki.com.cn/Article/CJFDTOTAL-DEJD201907003.htm [11] LEE A S, DE LENCASTRE H, GARAU J, et al. Methicillin-resistant Staphylococcus aureus[J]. Nat Rev Dis Primers, 2018, 4: 18033. doi: 10.1038/nrdp.2018.33
[12] HIRAMATSU K, KATAYAMA Y, MATSUO M, et al. Multi-drug-resistant Staphylococcus aureus and future chemotherapy[J]. J Infect Chemother, 2014, 20(10): 593-601. doi: 10.1016/j.jiac.2014.08.001
[13] 全国细菌耐药监测网. MRSA甲氧西林耐药金黄色葡萄球菌检出率[EB/OL]. (2021-11-18)[2022-05-03]. http://www.carss.cn/sys/Htmls/dist/index.html#/resistance.. [14] 全国细菌耐药监测网. 全国细菌耐药监测网2014—2019年胆汁细菌耐药监测报告[J]. 中国感染控制杂志, 2021, 20(1): 76-84. https://www.cnki.com.cn/Article/CJFDTOTAL-GRKZ202101008.htm [15] 夏照帆, 肖仕初, 葛绳德. 海军军医大学第一附属医院烧伤外科60年发展历程回顾[J]. 中华烧伤杂志, 2018, 34(11): 741-743. [16] MCGUINNESS W A, MALACHOWA N, DELEO F R. Vancomycin resistance in Staphylococcus aureus[J]. Yale J Biol Med, 2017, 90(2): 269-281.
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