某医院2013年金黄色葡萄球菌的耐药性及感染现状分析

目的：了解我院2013年金黄色葡萄球菌(Staphylococcus aureus,SAU)的感染现状及耐药性,为临床合理应用抗菌药物提供依据。方法收集分离我院2013年住院及门诊患者送检的SAU菌株共549株,并对其感染现状及耐药性进行分析。结果2013年共分离SAU共549株,占所有分离细菌的比例为8.6%,其中耐甲氧西林金黄色葡萄球菌(Methicil in resistant Staphylococcus aureus,MRSA)326株,在SAU中所占比例为59.4%。药敏结果显示,2013年我院SAU对青霉素的耐药率为96.1%,对万古霉素、替考拉宁及呋喃妥因的敏感性好,而对头孢唑林、氨苄西林-舒巴坦及红霉素等的耐药率均大于30%。326株MRSA菌株来自临床各个标本,如痰液、创面分泌物及脓液等,其中在痰液中检出菌株最多,占52.4%,其次为创面分泌物,占25.5%。临床科室中分离出MRSA最多的科室是重症监护室,占19.9%,其次是骨科、烧伤科和儿科,分别为14.1%、12.9%和12.6%。结论 MRSA的检出率高,临床上需要采取综合措施预防和控制MRSA感染。     

耐甲氧西林金黄色葡萄球菌的临床分布及耐药性分析

目的 熟悉耐甲氧西林金黄色葡萄球菌（MRSA）的临床分布及其耐药性,为临床提供参考。方法 采用VITEK2 COMPACT全自动微生物分析系统进行鉴定,筛选出MRSA菌株。结果 2017年1~12月我院分离出459株金黄色葡萄球菌,其中MRSA 98株,检出率为21.4%。儿科、创伤修复烧伤整形外科、神经外科检出MRSA较多。98株MRSA中,耐药率较高的抗菌药物有青霉素G、红霉素、克林霉素和四环素,万古霉素、利奈唑胺和呋喃妥因敏感率均为100.00%。结论 我院MRSA的检出率和耐药率形式仍然严     

苏州地区耐甲氧西林金黄色葡萄球菌的临床分布特点及耐药性分析

目的 探讨苏州高新区人民医院耐甲氧西林金黄色葡萄球菌(MRSA)的临床分布特点及其耐药性,为临床治疗葡萄球菌属感染提供正确选药依据.方法 对2015年1月至2017年8月苏州高新区人民医院临床各科送检的各类标本中分离鉴定出的MRSA,采用MIC法进行药敏试验,并探讨其临床分布与耐药特点.结果 分离出的170株金黄色葡萄球菌中,MRSA有40株,占23.5%,以呼吸科病房为最多(20株),占50.0%、其次是重症监护病房(ICU)、儿科、神经内科;多重耐药的MRSA对所有β-内酰胺类高度耐药,对大环内酯类耐药率为67.5%;对克林霉素类耐药性较高,其中红霉素诱导的克林霉素耐药率为47.5%,提示该药在苏州地区已不能够用于MRSA 感染的治疗.对氨基糖苷类、氟喹诺酮类耐药率较低(耐药率<30%),磺胺甲噁唑、甲氧苄啶及利福平具有良好的活性,尚未发现耐糖肽类和利萘唑胺的菌株.结论苏州地区近3年来MRSA菌株检出率较低;对常用抗菌素呈多重耐药,尤其是对大环内酯-克林霉素抗菌药物耐药率高.因此应加强对MRSA耐药率的监测,合理选抗菌药物,从而减少MRSA 的产生和传播.     

耐甲氧西林葡萄球菌的耐药状况分析

目的 分析耐甲氧西林葡萄球菌的耐药状况,了解葡萄球菌耐药的流行病学特征.方法 对251株临床分离的葡萄球菌进行耐药性检测,分析其药敏试验结果.结果 251株葡萄球菌中,金黄色葡萄球菌162株,其中耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA) 62株,阳性率为38.3%;凝固酶阴性葡萄球菌89株,其中耐甲氧西林凝固酶阴性葡萄球菌(methicillin-resistant coagulase negative Staphylococcus,MRCNS) 63株,阳性率为70.8%;所有菌株对万古霉素均敏感.结论 耐甲氧西林葡萄球菌对抗生素的耐药状况较为严重;未分离出万古霉素耐药株.     

2016年某院金黄色葡萄球菌感染分布及耐药性分析

目的 对2016年秦皇岛市第一医院患者金黄色葡萄球菌感染情况及耐药特点进行调查,为感染监控和临床用药提供参考.方法 回顾性分析2016年住院患者细菌培养标本中金黄色葡萄球菌的分离情况及耐药性.结果 共分离金黄色葡萄球菌311株,其中耐甲氧西林金黄色葡萄球菌(MRSA) 108株,占34.7％.金黄色葡萄球菌感染的标本来源主要有痰液(46.95％)、分泌物(34.73％)和全血(9.64％);感染科室主要以重症监护室、神经外科、儿科、老年病科、骨科多见.药物敏感性试验结果显示,MRSA耐药率明显高于甲氧西林敏感金黄色葡萄球菌(MSSA),未发现对万古霉素、替加环素耐药的菌株,对利奈唑胺和喹努普汀/达福普汀、呋喃妥因的敏感率也很高,但对克林霉素、红霉素耐药率达70％以上,而对青霉素的耐药率高达97.1％.结论 甲氧西林敏感金黄色葡萄球菌(MSSA)对部分抗菌药物仍保持较好的敏感性,而MRSA表现为多重药耐药性,应引起临床高度重视,临床应根据药物敏感性试验结果合理使用抗菌药物.     

耐甲氧西林金黄色葡萄球菌对消毒剂和常用抗菌药物的耐药性及相关基因的研究

耐甲氧西林金黄色葡萄球菌（methicillin-resistant Staphylococcus aureus ，MRSA）已成为医院感染的重要病原菌，流行、暴发常有报道，同时社区获得性感染亦逐年增多。金黄色葡萄球菌对甲氧西林耐药是由于获得了携带mec基因的葡萄球菌盒式染色体（staphylococcal cassette chromosome mec，SCCmec），并通过SCCmec不断积累抗生素耐药基因。近年来国内外学者已从金黄色葡萄球菌中检出耐消毒剂基因的菌株。因此，控制MRSA特别是对常用消毒剂如季铵盐类等消毒剂耐药菌株的传播具有实际意义。     

异质性万古霉素中介金黄色葡萄球菌检测方法的临床应用评价

近年来,随着甲氧西林耐药的金黄色葡萄球菌(MRSA)感染率的上升和万古霉素的广泛使用,临床上出现了万古霉素敏感性下降的金黄色葡萄球菌,包括万古霉素中介金黄色葡萄球菌(vancomycinintermediate Staphylococcus aureus,VISA)和异质性万古霉素中介金黄色葡萄球菌(heterogeneous vancomycin-intermediate Staphylococcus aureus,hVISA).2006年,美国临床和实验室标准协会(CLSI,原NCCLS)将万古霉素对金黄色葡萄球菌的折点进行了更新,但并未对hVISA做出明确的定义,也未推荐确认hVISA的标准方法[1].目前,hVISA的准确检测仍存在困难,其分离率和临床意义尚不明确.为此,本研究对国际上常用的3种检测方法进行比较分析,并评价它们的可靠性和临床应用价值,旨在寻找一种适用于临床实验室检测hVISA的简便易行的方法.     

76例金黄色葡萄球菌的耐药性分析

目的 了解临床分离的金黄色葡萄球菌耐药性.方法 采用常规方法分离鉴定菌种,并测定对青霉素等抗菌药物的耐药性. 结果葡萄球菌中甲氧西林耐药金黄色葡萄球菌(MRSA)有26株, MRSA的检出率为34.2%, MRSA除对万古霉素、氨苄西林较敏感外,对其余几种抗生素的敏感性均较低, MRSA 与MSSA对氯霉素等的耐药性差异有极显著性(P<0.01),对红霉素、万古霉素的耐药性差异无显著性(P>0.05).结论 切实加强实验室监测,对指导临床合理用药具有十分重要的意义.     

2013-2015年鲍曼不动杆菌感染分布特征与耐药性变迁

目的：了解徐医附院2013—2015年临床分离鲍曼不动杆菌的临床分布特征及对抗菌药物的耐药性变迁,为临床合理使用抗菌药物提供依据。方法：对2013—2015年徐医大附院收集的所有鲍曼不动杆菌临床数据进行分析。结果：2013—2015年共收集鲍曼不动杆菌1664株,其中在临床ICU科室检出率最高,占58.2%。临床分离的鲍曼不动杆菌耐药严重,其中对碳青霉烯类抗菌药物的耐药率已高达73.0%以上。对其他β内酰胺类、头孢菌素类等抗菌药物的耐药率总体维持在70.0%~80.0%之间。结论：鲍曼不动杆菌感染在ICU最为严重,且对常规抗生素耐药率普遍较高。应加强鲍曼不动杆菌耐药监测,以提高临床对感染性疾病的诊治疗效。     

耐甲氧西林金黄色葡萄球菌的分子生物学研究进展

耐甲氧西林金黄色葡萄球菌(Methicillin-resistant Staphylococcus aureus，MRSA)不仅对所有β-内酰胺类抗生素具有内在耐药性，而且通过获得其它耐药基因而呈现对多数其它类抗菌药的多重耐药性，给临床治疗带来严重问题。本从分子生物学水平就MRSA耐药决定因子(mec)与辅助基因(fem)在耐药性产生中的作用作一简要综述。     

甲氧西林耐药的金黄色葡萄球菌耐药性及分子流行病学调查

目的了解甲氧西林耐药的金黄色葡萄球菌(MRSA)的耐药性及分子流行病学特点。方法采用纸片扩散法及琼脂稀释法检测2002年从北京协和医院住院患者分离的165株MRSA的耐药性；采用脉冲场凝胶电泳(PFGE)技术对其中重症监护病房(ICU)和呼吸重症监护病房(RCU)分离的65株MRSA作同源性分析。结果165株MRSA对万古霉素和替考拉宁的敏感率为100％，对庆大霉素的耐药率为100％；对左氧氟沙星、四环素、红霉素耐药率分别为98．2％、96．3％、93．9％。对甲氧苄啶，磺胺甲噁唑和氯霉素敏感率分别为95．8％及98．8％；ICU和RCU病房分离MRSA的PFGE图谱有5种类型(A—E型)，以A型为主(56株)，A型又包括A1亚型(55株)和A2亚型(1株)。结论医院获得性MRSA是多重耐药菌，在ICU和RCU病房发生了基因型为A1亚型的MRSA菌株暴发流行。     

A high frequency of macrolide-lincosamide-streptogramin resistance determinants in Staphylococcus aureus isolated in South Korea

Genes conferring resistance to one of the macrolide-lincosamide-streptogramin (MLS) antibiotics may confer cross-resistance to others, because they have similar effects on bacterial protein synthesis. In Korea, over 70% of Staphylococcus aureus isolates are methicillin-resistant and erythromycin-resistant methicillin-resistant S. aureus (MRSA) is also prevalent. We investigated the frequency of MLS resistance in erythromycin-resistant S. aureus isolates. A total of 682 isolates of S. aureus were collected in a nationwide antibiotic resistance survey. Susceptibility to erythromycin, clindamycin, and quinupristin/dalfopristin was tested by disk diffusion. In all, 37% of the methicillin-susceptible S. aureus (MSSA) and 97% of the MRSA isolates were resistant to at least one of the MLS antibiotics, whereas all were susceptible to quinupristin/dalfopristin. Out of 518 strains that were resistant to erythromycin, 60 clindamycin-susceptible (30 MSSA, 30 MRSA) and 44 clindamycin-resistant isolates (14 MSSA, 30 MRSA) were selected at random from these strains. Thirteen genes related to MLS resistance were detected in these isolates by PCR. Of the 104 MSSA and MRSA strains tested, 98 harbored one or more erm gene. The most common was erm(A), with erm(C) next. But, msr(A), lnu(A), and mef(A) were rare and no resistance to streptogramin A was encountered.     

汕头大学医学院附属第一医院耐甲氧西林金黄色葡萄球菌(MRSA)耐药谱分析

目的:了解汕头大学医学院附属第一医院分离的92株耐甲氧西林金黄色葡萄球菌(MRSA)的耐药情况。方法:琼脂稀释法测定17种抗菌药物对MRSA的最低抑菌浓度(MIC)。结果:92株MRSA对实验中所有β-内酰胺类抗生素的耐药率均在80%以上。绝大部分菌株对庆大霉素、红霉素、氟喹诺酮类也不敏感。超过半数的MRSA菌株对利福平保持敏感,对氯霉素、多西环素及米诺环素也普遍敏感,未发现耐万古霉素的MRSA菌株。结论:我院附属第一医院的MRSA呈多重耐药,但对氯霉素,半合成四环素及万古霉素仍然敏感。     

烧伤病房金黄色葡萄球菌分离株的分子分型及其耐药性

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) infection had been a global problem up to 1980s, and it has become a leading pathogen giving rise to nosocomial infections now. OBJECTIVE: To determine the molecular types and drug susceptibilities of Staphylococcus aureus prevailed in burn ward, and to provide a basis for preventing and controlling MRSA intections. METHODS: A total of 53 Staphylococcus aureus strains were collected from the burn ward in the Urumqi General Hospital of Lanzhou Military Region of Chinese PLA. These MRSA strains were identified by PCR and cefoxitin disc diffusion test, and all MRSA strains were typed by spa, SCCmec and MLST typing. In the meanwhile, antibiotic susceptibilities of 17 kinds of drugs, such as oxacillin, to Staphylococcus aureus were also determined, and drug resistance of different types of Staphylococcus aureus especially MRSA, was analyzed. RESULTS AND CONCLUSION:Among 53 Staphylococcus aureus strains, 43 were identified as MRSA, containing determined for amplification of meoA (n=41) and positive for cefoxitin disc diffusion test (n=2). Three SCCmec types, four spa types, and three ST types were found. The major predominant clone was ST239-MRSA-III-t030 (90.7%), with highest resistant to oxacillin and other nine antibiotics. In conclusion, the higher MRSA isolation rate from the burn ward, and ST239-MRSA-III-t030, as the predominant clone, presents with an outbreak in the burn ward and stronger resistance to many different families of antibiotics.       

In vitro activities of eight antibiotics against methicillin-resistant S. aureus and S. epidermidis strains isolated in Korea

Staphylococcus aureus and Staphylococcus epidermidis strains isolated at eight large medical centers in Korea were examined for methicillin resistance and resistance to eight other antibiotics; cefazolin, cefamandole, cefuroxime, cefoxitin, cefotaxime, moxalactam, penicillin G and vancomycin. Methicillin resistance was found in 296 of 1225 strains (24.2%) of S. aureus and 126 of 348 strains (36.2%) of S. epidermidis. Methicillinresistant strains were isolated from all sources with the frequency of isolation ranging from 11% to 60%. From pleural effusion, throat swab and blood, methicillin-resistant strains of S. aureus were more frequently isolated with statistical significance (Chi-squared test, 95% confidence). Almost all of Methicillin-resistant S. aureus (MRSA) and S. epidermidis (MRSE) strains were multiply resistant to one or more tested eight antibiotics. However only 7(2.4%) of 296 MRSA strains and 2(1.6%) of 126 MRSE strains were resistant to vancomycin. Vancomycin was the most effective antibiotic against staphylococcal isolates as well as MRSA and MRSE.     

Resistance to linezolid in Staphylococcus aureus before its release

Resistance to antibiotics is a global problem in geriatric centres. OBJECTIVE: The aim of this study was to determine the frequency of the resistance to linezolid in Staphylococcus aureus strains before its release in a geriatric centre. METHOD: From 03-01-01 to 03-04-30 linezolid was included in the panel of antibiotics tested in S. aureus strains. The susceptibilities were estimated by the disk diffusion test in routine clinical microbiology practice. RESULTS: A total of 213 strains of S. aureus was analysed. All of them were susceptible to the following antibiotics: linezolid, cotrimoxazol, fosfomycin, and glycopeptides. The meticillin-resistant S. aureus (MRSA) represented 67.1% (60.3-73.3) strains. The resistance to pefloxacin, tobramycin and erythromycin concerned 92.3% (86.3-95.9), 73.4% (65.3-80.3) and 31.5% (24.1-39.8) of MRSA strains respectively. The MRSA strains were less resistant to the following antimicrobial drugs: gentamicin 7.0% (3.6-12.8), fusidic acid 2.1% (0.5-6.5) and rifampicin 1.4% (0.2-5.5). The resistance concerning at the same time gentamicin, pefloxacin and fucidic acid represented 2.1% (0.5-6.5) of SARM strains, rifampicin was not interested. CONCLUSION: Linezolid was effective in vitro in S. aureus strains regardless their susceptibilities in meticillin. According to its effectiveness in vivo, linezolid may be of use for the treatment of infections due to MRSA. However, there has been two reports of resistance of MRSA in clinical infections. The use of linezolid has to follow the instructions and it should be carefully monitored.     

新生儿败血症致病菌分布及耐药性分析

目的 研究新生儿败血症感染致病菌分布及耐药性情况,为临床合理用药提供理论依据。方法 通过医院信息管理系统对我院2015年4月~2018年4月在围产儿科住院的共111例新生儿败血症的临床资料进行回顾性分析,对其所采血培养结果进行分析。结果 111例新生儿败血症患儿共检出菌株113株,其中革兰氏阳性菌103株（91.15%）,革兰氏阴性菌10株（8.85%）,真菌检出（0%）。革兰氏阳性菌以凝固酶阴性葡萄球菌（表皮葡萄球菌58株、溶血性葡萄球菌12株、人葡萄球菌9株、沃氏葡萄球菌3株）、粪肠球菌、金黄色葡萄球菌为主,分别为82株（72.57%）、10株（8.85%）、7株（6.19%）;革兰氏阴性菌以大肠埃希菌为主,共7株（6.19%）。革兰氏阳性球菌是新生儿败血症的主要病原菌,其对青霉素、红霉素及苯唑西林耐药率高,对万古霉素、替考拉宁100.00%敏感。革兰氏阴性菌对氨苄青霉素舒巴坦、氨苄西林、复方新诺明耐药率高,对亚胺培南、美洛培南敏感。结论 根据血培养药敏结果,选择敏感抗菌药物,合理使用抗生素,可减少细菌耐药的发生,提高临床治疗效果。