谭艳　　傅建国　　岳蓓

[摘要] 目的 分析成人耐甲氧西林金黃色葡萄球菌（MRSA）感染的临床特征和耐药性，为临床感染控制和合理用药提供依据。 方法 回顾性分析2018年1—12月厦门市某三甲医院住院患者中137例成人金黄色葡萄球菌感染，按甲氧西林耐药性分为耐甲氧西林金黄色葡萄球菌的MRSA组和甲氧西林敏感的金黄色葡萄球菌（MSSA）的MSSA组，分析两组的临床资料和耐药性。 结果 MRSA组以外科系统、重症监护病房检出为主，送检标本以呼吸道标本居多（P=0.000）;MRSA组合并神经系统疾病、侵入性操作、感染前抗生素使用情况（超过2种）、合并感染明显高于MSSA组;MRSA组病死率高于MSSA组（P均<0.05）;合并神经系统疾病、实施侵入性操作是MRSA感染的独立危险因素;MRSA组对克林霉素、红霉素、环丙沙星、庆大霉素、利福平、妥布霉素、四环素、左氧氟沙星、美满霉素的耐药率明显高于MSSA组，差异有统计学意义（P均<0.05）。 结论 耐甲氧西林金黄色葡萄球菌感染病死率高;合并神经系统疾病、实施侵入性操作是MRSA感染的危险因素，MRSA菌株对多种抗生素耐药，临床应加强监测，根据药敏合理选择治疗药物。

[关键词] 耐甲氧西林金黄色葡萄球菌;临床特征;危险因素;耐药性

[中图分类号] R378.1          [文献标识码] B          [文章编号] 1673-9701（2021）13-0111-04

Analysis on the clinical characteristics and drug resistance of adult methicillin-resistant staphylococcus aureus infection

TAN Yan1   FU Jianguo2   YUE Bei1

1.Infectious Diseases Department， Zhongshan Hospital， Xiamen University， Xiamen Fujian   361004， China; 2.Hospital-Acquired Infection Control Department， Zhongshan Hospital， Xiamen University， Xiamen Fujian   361004， China

[Abstract] Objective To analyze the clinical characteristics and drug resistance of methicillin-resistant Staphylococcus aureus（MRSA） infection in adults， and provide evidence for clinical infection control and rational drug use. Methods A total of 137 adult cases of Staphylococcus aureus infection among inpatients in a tertiary hospital in Xiamen from January to December 2018 were retrospectively analyzed. According to methicillin resistance， the patients were divided into the MRSA group of methicillin-resistant Staphylococcus aureus and the MSSA group of methicillin-sensitive Staphylococcus aureus（MSSA）. The clinical data and drug resistance were analyzed in both groups. Results The MRSA group was mainly detected by the surgical system and intensive care unit， and most of the specimens submitted for examination were respiratory specimens（P=0.000）; complicated neurological diseases， invasive procedures， pre-infection antibiotic usage（more than 2 types）， and complicated infection in the MRSA group were significantly higher than those in the MSSA group （P<0.05 for all）; the mortality rate in the MRSA group was higher than that in the MSSA group （P<0.05 for all）; complicated neurological diseases and invasive procedures were independent risk factors for MRSA infection; the resistance rates to clindamycin， erythromycin， ciprofloxacin， gentamicin， rifampicin， tobramycin， tetracycline， levofloxacin， and minocycline in the MRSA group was significantly higher than those in the MSSA group， and the differences were statistically significant（P<0.05 for all）. Conclusion The mortality of methicillin-resistant Staphylococcus aureus infection is high; complicated neurological diseases and invasive procedures are risk factors for MRSA infection. MRSA strains are resistant to a variety of antibiotics， and clinical surveillance should be strengthened， and therapeutic drugs should be selected based on drug sensitivity.

[Key words] Methicillin-resistant Staphylococcus aureus（MRSA）; Clinical characteristics; Risk factors; Drug resistance

金黄色葡萄球菌是临床上常见的革兰染色阳性球菌，能产生多种霉素、酶及抗原蛋白，能引起皮肤软组织感染、血流感染及全身各脏器感染，具有较强的致病力。根据其对甲氧西林药物的敏感性将其分为甲氧西林敏感金黄色葡萄球菌（Methicillin-sensitive staphylococcus aureus，MSSA）和耐甲氧西林金黄色葡萄球菌（Methicillin-resistant staphylococcus aureus，MRSA）。1961年临床上首次分离出MRSA，该细菌对所有的β类抗生素耐药，并对大环内酯类、氨基糖苷类、氟喹诺酮类等抗菌药物多数耐药，导致其所致感染治疗困难，病死率高[1]。20世纪80年代后医院内MRSA感染逐年增多，该菌成为医院感染的主要病原菌之一[2]。随着抗菌药物种类的不断增加和临床使用，MRSA感染也在逐年增加。由于MRSA具有体外存活时间长，极易通过直接或者间接医院内或者社区内MRSA定植者而传播从而导致MRSA感染率不断升高，已经成为公共卫生领域的重大挑战[3-4]。……