金黄色葡萄球菌是我国儿童及新生儿革兰阳性菌感染的主要病原,其中MRSA (耐甲氧西林金黄色葡萄球菌)的检出率逐渐上升,耐药范围逐渐扩大,耐药程度也日益加重,临床上可以导致多种类型的难治性感染。MRSA不仅对青霉素耐药,对和青霉素结构...金黄色葡萄球菌是我国儿童及新生儿革兰阳性菌感染的主要病原,其中MRSA (耐甲氧西林金黄色葡萄球菌)的检出率逐渐上升,耐药范围逐渐扩大,耐药程度也日益加重,临床上可以导致多种类型的难治性感染。MRSA不仅对青霉素耐药,对和青霉素结构相同或相似的β-内酰胺类抗生素均耐药,甚至对氨基糖苷类、大环内酯类、喹诺酮类等抗菌药物产生耐药,极大的增加了医疗负担。儿童感染性疾病发生率较成人高,抗菌药物使用率高,加之抗菌药物可选择种类少,且儿童MRSA感染治疗是目前抗感染的重点,因此对儿童医院进行MRSA感染的研究更有临床意义。目的:分析某三甲儿童医院耐甲氧西林金黄色葡萄球菌检出率、临床分布及耐药情况,为临床合理使用抗菌药物及医院感染预防与控制起到指导性工作。方法:回顾性分析2019年1月1日~2020年12月31日某三甲儿童医院住院患儿临床标本中分离出的MRSA菌株,对其检出率、来源分布及药敏试验等进行统计分析。结果:2019~2020年该院共检出金黄色葡萄球菌322株,其中MRSA 202株,总检出率为62.73%,各年度MRSA检出率呈现逐年下降的趋势;MRSA科室分布结果表明,排名前3位的科室分别为普外科(18.32%)、新生儿外科(14.36%)、骨科(13.37%);标本来源结果表明,标本类型主要为脓(42.08%)、咽拭子(15.35%)、痰液(14.36%);年龄分布结果表明,1岁以内的患儿检出MRSA菌株数量最多,占比为49.50%;药敏结果表明,MRSA菌株对青霉素、苯唑西林、红霉素、克林霉素耐药率大于70%,未发现对利奈唑胺、万古霉素、替考拉宁耐药的MRSA菌株。结论 该院MRSA检出率呈下降趋势,低龄患儿发生MRSA感染的风险较大,应重点关注外科,并依据药物敏感试验结果,合理使用抗菌药物。Staphylococcus aureus is the main pathogen of gram-positive bacteria infection in children and newborns in China, among which the detection rate of MRSA (methicillin-resistant Staphylococcus aureus) has gradually increased, the scope of drug resistance has gradually expanded, and the degree of drug resistance has become increasingly aggravated, which can lead to various types of refractory infections clinically. MRSA is resistant not only to penicillin, but also to β-lactam antibiotics with the same or similar structure as penicillin, and even to aminoglycosides, macrolides, quinolones and other antibiotics, which greatly increases the medical burden. The incidence of infectious diseases in children is higher than that in adults, the utilization rate of antibiotics is high, the types of antibiotics available are few, and the treatment of MRSA infection in children is currently the focus of anti-infection, so it is more clinical significance to study MRSA infection in children’s hospitals. Objective: To analyze the detection rate, clinical distribution and drug resistance of methicillin-resistant Staphylococcus aureus in a Class III children's hospital, so as to provide guidance for rational use of antibiotics and nosocomial infection prevention and control. Methods: MRSA strains isolated from clinical specimens of hospitalized children from a Class III children's hospital from January 1, 2019 to December 31, 2020 were retrospectively analyzed, and their detection rate, source distribution and drug susceptibility test were statistically analyzed. Results: A total of 322 strains of Staphylococcus aureus were detected in the hospital from 2019 to 2020, including 202 strains of MRSA, the total detection rate was 62.73%, and the detection rate of MRSA showed a trend of year by year decline. The distribution results of MRSA departments showed that the top 3 departments were general surgery (18.32%), neonatal surgery (14.36%) and orthopedics (13.37%). The main specimen types were pus (42.08%), throat swab (15.35%) and sputum (14.36%). The results of age distribution showed that the number of MRSA strains was the highest in children under 1 year old, accounting for 49.50%. The drug susceptibility results showed that the resistance rate of MRSA strains to penicillin, oxacillin, erythromycin and clindamycin was more than 70%, and no MRSA strains resistant to linezolid, vancomycin and teicolanin were found. Conclusion The detection rate of MRSA in our hospital showed a downward trend, and the risk of MRSA infection in young children was greater. We should pay attention to the surgery department and rationally use antibiotics according to the results of drug sensitivity test.展开更多
文摘金黄色葡萄球菌是我国儿童及新生儿革兰阳性菌感染的主要病原,其中MRSA (耐甲氧西林金黄色葡萄球菌)的检出率逐渐上升,耐药范围逐渐扩大,耐药程度也日益加重,临床上可以导致多种类型的难治性感染。MRSA不仅对青霉素耐药,对和青霉素结构相同或相似的β-内酰胺类抗生素均耐药,甚至对氨基糖苷类、大环内酯类、喹诺酮类等抗菌药物产生耐药,极大的增加了医疗负担。儿童感染性疾病发生率较成人高,抗菌药物使用率高,加之抗菌药物可选择种类少,且儿童MRSA感染治疗是目前抗感染的重点,因此对儿童医院进行MRSA感染的研究更有临床意义。目的:分析某三甲儿童医院耐甲氧西林金黄色葡萄球菌检出率、临床分布及耐药情况,为临床合理使用抗菌药物及医院感染预防与控制起到指导性工作。方法:回顾性分析2019年1月1日~2020年12月31日某三甲儿童医院住院患儿临床标本中分离出的MRSA菌株,对其检出率、来源分布及药敏试验等进行统计分析。结果:2019~2020年该院共检出金黄色葡萄球菌322株,其中MRSA 202株,总检出率为62.73%,各年度MRSA检出率呈现逐年下降的趋势;MRSA科室分布结果表明,排名前3位的科室分别为普外科(18.32%)、新生儿外科(14.36%)、骨科(13.37%);标本来源结果表明,标本类型主要为脓(42.08%)、咽拭子(15.35%)、痰液(14.36%);年龄分布结果表明,1岁以内的患儿检出MRSA菌株数量最多,占比为49.50%;药敏结果表明,MRSA菌株对青霉素、苯唑西林、红霉素、克林霉素耐药率大于70%,未发现对利奈唑胺、万古霉素、替考拉宁耐药的MRSA菌株。结论 该院MRSA检出率呈下降趋势,低龄患儿发生MRSA感染的风险较大,应重点关注外科,并依据药物敏感试验结果,合理使用抗菌药物。Staphylococcus aureus is the main pathogen of gram-positive bacteria infection in children and newborns in China, among which the detection rate of MRSA (methicillin-resistant Staphylococcus aureus) has gradually increased, the scope of drug resistance has gradually expanded, and the degree of drug resistance has become increasingly aggravated, which can lead to various types of refractory infections clinically. MRSA is resistant not only to penicillin, but also to β-lactam antibiotics with the same or similar structure as penicillin, and even to aminoglycosides, macrolides, quinolones and other antibiotics, which greatly increases the medical burden. The incidence of infectious diseases in children is higher than that in adults, the utilization rate of antibiotics is high, the types of antibiotics available are few, and the treatment of MRSA infection in children is currently the focus of anti-infection, so it is more clinical significance to study MRSA infection in children’s hospitals. Objective: To analyze the detection rate, clinical distribution and drug resistance of methicillin-resistant Staphylococcus aureus in a Class III children's hospital, so as to provide guidance for rational use of antibiotics and nosocomial infection prevention and control. Methods: MRSA strains isolated from clinical specimens of hospitalized children from a Class III children's hospital from January 1, 2019 to December 31, 2020 were retrospectively analyzed, and their detection rate, source distribution and drug susceptibility test were statistically analyzed. Results: A total of 322 strains of Staphylococcus aureus were detected in the hospital from 2019 to 2020, including 202 strains of MRSA, the total detection rate was 62.73%, and the detection rate of MRSA showed a trend of year by year decline. The distribution results of MRSA departments showed that the top 3 departments were general surgery (18.32%), neonatal surgery (14.36%) and orthopedics (13.37%). The main specimen types were pus (42.08%), throat swab (15.35%) and sputum (14.36%). The results of age distribution showed that the number of MRSA strains was the highest in children under 1 year old, accounting for 49.50%. The drug susceptibility results showed that the resistance rate of MRSA strains to penicillin, oxacillin, erythromycin and clindamycin was more than 70%, and no MRSA strains resistant to linezolid, vancomycin and teicolanin were found. Conclusion The detection rate of MRSA in our hospital showed a downward trend, and the risk of MRSA infection in young children was greater. We should pay attention to the surgery department and rationally use antibiotics according to the results of drug sensitivity test.
