58株致肺炎金黄色葡萄球菌耐药性分布及耐药菌体外诱导耐药情况分析

许恒贵

[摘要] 目的 以58株金黄色葡萄球菌为例，分析其耐药性分布，指导临床抗生素的合理使用。通过体外诱导耐药，初步探讨其耐药机制。方法 整群选取该院2013年3月—2014年3月临床分离得到的58株金黄色葡萄球菌，进行药敏实验，分析其耐药性分布。通过体外诱导法建立金黄色葡萄球菌的耐药模型，初步探讨其耐药机制。 结果 58株金黄色葡萄球菌中，分离出32株耐甲氧西林金黄色葡萄球菌（MRSA），占金黄色葡萄球菌的55.2%。金黄色葡萄球菌主要分布在ICU病房、呼吸内科以及神经外科。主要感染标本为痰液和分泌物。所分离到的58株菌对万古霉素和利奈唑胺均敏感，青霉素耐药率为98.3%。 结论 金黄色葡萄球菌主要分布在门诊、ICU等科室，且耐药菌株的数量已不容乐观，应引起临床上的足够重视，加强抗生素合理使用的管理以及对金黄色葡萄球菌感染的监测。

[关键词] 金黄色葡萄球菌；耐药性；体外诱导耐药

[中图分类号] R563.1 [文献标识码] A [文章编号] 1674-0742（2015）12（a）-0040-03

[Abstract] Objective To analyze the drug resistance distribution by taking 58 strains of staphylococcus aureus for example in order to guide the rational use of clinical antibiotics and preliminarily discuss the drug resistance mechanism by in vitro induction of resistance. Methods 58 strains of Staphylococcus aureus obtained by clinical isolates from March 2013 to March 2014 were selected and the drug resistance distribution of them were analyzed by drug sensitivity test， the drug resistance model of staphylococcus aureus was built by in vitro induction method and its drug resistance mechanism was preliminarily discussed. Results 32 strains of staphylococcus aureus（MRSA） were separated from 58 strains of staphylococcus aureus， accounting for 55.2% of staphylococcus aureus， staphylococcus aureus was mainly distributed in the ICU ward， respiratory department of internal medicine and department of neurosurgery， the main infection specimens were sputum and secretion， the isolated 58 strains were sensitive to vancomycin and linezolid， the drug resistance rate of penicillin was 98.3%. Conclusion Staphylococcus aureus is mainly distributed in the clinic， ICU and other departments and the number of resistant strains is not optimistic， and we should pay enough attention to it in clinic by strengthening the management of antibiotics and monitoring of staphylococcus aureus infection.

[Key words] Staphylococcus aureus； Drug resistance； In vitro induction of resistance

金黄色葡萄球菌（staphylococcus aureus）是近年来临床常见的主要致病菌，属于革兰氏阳性菌。金黄色葡萄球菌可引起皮肤软组织感染、重型肺炎、导管相关性感染、感染性心内膜炎以及血液感染等疾病，且其极易形成生物膜（BBF）[1]，加大了治疗难度。半个多世纪前，抗生素的发现开辟了医疗革命的新时代，但随着抗生素的广泛使用，甚至是滥用，导致了耐药菌的产生，且数量在逐年增加[2]。为了进一步了解金黄色葡萄球菌的分布和耐药性，该研究整群选取该院2013年3月—2014年3月临床分离得到的58株金黄色葡萄球菌进行分析，现报道如下。……