2018~2023年内蒙古地区某三甲医院耐甲氧西林金黄色葡萄球菌的临床分布及耐药性变迁

Clinical Distribution and Drug Resistance Changes of Methicillin-Resistant Staphylococcus aureus in a Third-Class A Hospital in Inner Mongolia from 2018 to 2023

摘要: 目的：了解耐甲氧西林金黄色葡萄球菌临床感染现状和耐药变化趋势，为临床防治提供依据。方法：对2018年1月至2023年12月间，鄂尔多斯市中心医院门诊及住院患者所分离出的耐甲氧西林金黄色葡萄球菌标本来源、临床感染科室分布及耐药性变迁进行回顾性分析。采用全自动微生物鉴定仪对菌株进行鉴定和药敏试验，采用K-B纸片扩散法和E-test法进行补充试验。结果：2018~2023年共收集到219株MRSA，占总检出SAU的18.56%。科室中主要分离科室为重症医学科占22.83%，其次为神经外科占12.79%。标本以痰液标本为主，占59.82%，其次为分泌物占18.26%。MRSA与MSSA对利奈唑胺、达托霉素、万古霉素、替考拉宁四种药物尚未产生耐药性；但MRSA对复方新诺明的耐药性低于MSSA (p < 0.01)；除此外，MRSA对青霉素G、庆大霉素、左氧氟沙星、莫西沙星、利福平、克林霉素等耐药情况普遍高于MSSA。六年来，219株MRSA对青霉素G、苯唑西林、头孢西丁均100.00%耐药；2018~2022年MRSA对庆大霉素、莫西沙星的耐药率逐年降低，但2022~2023年有所升高；对左氧氟沙星的耐药率2018~2021年一直呈下降趋势，但2021~2023年呈上升趋势，对克林霉素与红霉素的耐药率均在2022年达高峰，并于2023年有所下降；对达托霉素、利奈唑胺、万古霉素、替考拉宁四类药物尚未产生耐药性，以上数据均p < 0.01。结论：MRSA对多种抗生素的耐药率仍呈较高水平，且MRSA检出率逐年升高，这说明采取一定措施，降低MRSA对常用抗生素的耐药性非常有必要。这要求我们加强院感监控机制，合理使用抗生素，密切检测其耐药性变迁，为临床使用抗生素提供更多依据。

Abstract: Objective: To investigate the current status of clinical infection and the trend of drug resistance of methicillin-resistant Staphylococcus aureus, and to provide a basis for clinical prevention and treatment. Methods: Conduct a retrospective analysis on the specimen sources, distribution in clinical infection departments, and alterations in the drug resistance of methicillin-resistant Staphylococcus aureus isolated from both outpatient and inpatient individuals in Ordos Central Hospital spanning from January 2018 to December 2023. The automatic microbial identification instrument was used to identify the strains and the antimicrobial susceptibility test, and the K-B disc diffusion method and E-test method were used to carry out supplementary tests. Results: A total of 219 MRSA strains were collected from 2018 to 2023, accounting for 18.56% of the total detected SAU. Among the departments, the main separate department was intensive care medicine, accounting for 22.83%, followed by neurosurgery (12.79%). Sputum samples were the main specimens, accounting for 59.82%, followed by secretion (18.26%). MRSA and MSSA have not yet developed resistance to daptomycin, linezolid, vancomycin, and teicoplanin; However, MRSA was less resistant to cotrimoxazole than MSSA (p < 0.01); Furthermore, resistance to penicillin G, gentamicin, rifampicin, levofloxacin, moxifloxacin, clindamycin, and so forth, is generally higher in MRSA than in MSSA. In the past six years, 219 MRSA strains were 100.00% resistant to penicillin G, oxacillin and cefoxitin. From 2018 to 2022, the resistance rate of MRSA to gentamicin and moxifloxacin decreased year by year, but increased from 2022 to 2023. The resistance rate to levofloxacin has been on a downward trend from 2018 to 2021, but has shown an upward trend from 2021 to 2023, and the resistance rates to clindamycin and erythromycin both peaked in 2022 and decreased in 2023. Resistance to daptomycin, linezolid, vancomycin, and teicoplanin has not yet been developed, and the above data are all p < 0.01. Conclusion: The resistance rate of MRSA to a variety of antibiotics is still at a high level, and the detection rate of MRSA is increasing year by year, which indicates that it is necessary to take certain measures to reduce the resistance of MRSA to commonly used antibiotics. This requires us to strengthen the monitoring mechanism of hospital infection, use antibiotics rationally, and closely monitor the changes in drug resistance, so as to provide more evidence for the clinical use of antibiotics.