MRSA的流行病学及耐药性研究
发布时间：2018-11-03 17:53
【摘要】：目的：调查本院耐甲氧西林金黄色葡萄球菌(MRSA)的感染患者的临床特点及其耐药情况,并对临床标本MRSA和环境微生物学监测的MRSA进行耐药谱分析,探讨同源性,为MRSA感染预防控制及治疗提供确实可靠的依据。方法：采用回顾调查方法对MRSA感染患者相关临床资料进行统计分析,了解本院MRSA感染分布、耐药情况；收集40例MRSA感染患者临床标本,并采集其对应医院环境微生物标本,对阳性标本进行药敏实验,对照药敏谱分析其同源性。结果：1)在调查的71例MRSA患者中,男44人,女27人,平均年龄47.32±23.61岁,医院获得性耐甲氧西林金黄色葡萄球菌(HA-MRSA)54例(76.06%),HA-MRSA感染率为0.11%,社区获得性耐甲氧西林金黄色葡萄球菌(CA-MRSA)17例(23.94%)；2) HA-MRSA以呼吸道、手术部位、皮肤软组织为主,CA-MRSA以皮肤软组织为主,和HA-MRSA存在明显差异；呼吸道感染在社区和医院感染中比例均较高。两者在年龄、住院天数、是否住ICU、是否手术、感染前是否进行侵入性操作等作等方面存在明显差异,HA-MRSA对利福平、庆大霉素、莫西沙星、环丙沙星的耐药性率高于CA-MRSA (P0.05);3) HA-MRSA感染率重症监护病区高于普通病区,二者差别有统计学意义(P0.05)；重症监护病区以呼吸道感染(61.11%)和血液感染(27.78%)为主,而普通病区以手术部位感染(47.22%)和皮肤软组织MRSA感染(19.44%)为主,不同病区医院感染部位构成比有差异(P0.05)；重症监护病区和普通病区MRSA院内感染患者在年龄、基础疾病、插入性操作、手术、疾病转归方面均存在差异(P0.05)；4)采集环境中空气、各类表面、工作人员手共121份标本,培养出MRSA4株,通过耐药谱分析显示细菌具有高度同源性。结论：1)应加强对CA-MRSA监测,及时发现并通过隔离等措施控制社区感染源和带菌者,应加强对老年人及具有感染危险因素患者的HA-MRSA监测,及时发现感染风险并采取有效的预防措施；2)重症监护区和普通病区MRSA院内感染存在差异,在MRSA医院感染预防与控制方面,重症监护病区和普通病区侧重点应当有所不同；3)环境中检出的标本和患者临床标本存在同源性,在我院MRSA感染存在交叉感染的隐患,应加大MRSA感染患者周围环境的清洁与消毒工作。
[Abstract]:Objective: to investigate the clinical characteristics and drug resistance of patients with methicillin-resistant Staphylococcus aureus (MRSA) infection in our hospital, and to analyze the resistance spectrum of MRSA in clinical samples and MRSA monitored by environmental microbiology, and to explore the homology. To provide a reliable basis for the prevention, control and treatment of MRSA infection. Methods: the clinical data of patients with MRSA infection were analyzed retrospectively to find out the distribution and drug resistance of MRSA infection in our hospital. The clinical specimens of 40 patients with MRSA infection were collected, and the microorganism samples of corresponding hospital environment were collected. The drug sensitivity test was carried out on the positive samples, and the homology was analyzed by the control drug sensitivity spectrum. Results: 1) of 71 patients with MRSA, 44 were male and 27 female, with an average age of 47.32 卤23.61 years. 54 cases (76.06%) of hospital acquired methicillin resistant Staphylococcus aureus (HA-MRSA) were found. The infection rate of HA-MRSA was 0.11%, 17 cases (23.94%) of community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA). 2) Respiratory tract, surgical site, skin soft tissue were dominant in HA-MRSA, skin soft tissue was dominant in CA-MRSA, and there was significant difference between HA-MRSA and respiratory tract infection, and the proportion of respiratory tract infection in community and nosocomial infection was higher. There were significant differences between the two groups in age, length of stay in hospital, whether or not ICU, was operated on, whether invasive operation was performed before infection, and so on. There were significant differences between the two groups in the treatment of rifampicin, gentamycin, moxifloxacin, and so on. The drug resistance rate of ciprofloxacin was higher than that of CA-MRSA (P0.05). 3) the infection rate of HA-MRSA in intensive care area was higher than that in common ward, the difference was statistically significant (P0.05). Respiratory tract infection (61.11%) and blood infection (27.78%) were the main diseases in the intensive care area, while in the common ward, the infection in the surgical site (47.22%) and the skin and soft tissue MRSA infection (19.44%). The proportion of nosocomial infection sites in different areas was different (P0.05). MRSA nosocomial infection patients in intensive care ward and general ward were different in age, basic disease, inserted operation, operation and disease outcome (P0.05). 4) A total of 121 samples were collected from air, various surfaces and workers' hands, and MRSA4 strains were cultured. The results of drug resistance analysis showed that the bacteria had high homology. Conclusion: 1) the monitoring of CA-MRSA should be strengthened to detect and control the source of infection and the carriers in the community in time, and the monitoring of HA-MRSA in the elderly and patients with risk factors of infection should be strengthened. Identify the risk of infection in time and take effective preventive measures; 2) there were differences in MRSA nosocomial infection between the intensive care area and the general ward. In the aspect of the prevention and control of MRSA nosocomial infection, the emphasis of the intensive care ward and the general ward should be different. 3) there is homology between the samples detected in the environment and the clinical specimens of the patients. There is a hidden danger of cross infection in the MRSA infection in our hospital, so the cleaning and disinfection of the surrounding environment of the patients with MRSA infection should be increased.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R446.5;R378.11
本文编号：2308518
[Abstract]:Objective: to investigate the clinical characteristics and drug resistance of patients with methicillin-resistant Staphylococcus aureus (MRSA) infection in our hospital, and to analyze the resistance spectrum of MRSA in clinical samples and MRSA monitored by environmental microbiology, and to explore the homology. To provide a reliable basis for the prevention, control and treatment of MRSA infection. Methods: the clinical data of patients with MRSA infection were analyzed retrospectively to find out the distribution and drug resistance of MRSA infection in our hospital. The clinical specimens of 40 patients with MRSA infection were collected, and the microorganism samples of corresponding hospital environment were collected. The drug sensitivity test was carried out on the positive samples, and the homology was analyzed by the control drug sensitivity spectrum. Results: 1) of 71 patients with MRSA, 44 were male and 27 female, with an average age of 47.32 卤23.61 years. 54 cases (76.06%) of hospital acquired methicillin resistant Staphylococcus aureus (HA-MRSA) were found. The infection rate of HA-MRSA was 0.11%, 17 cases (23.94%) of community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA). 2) Respiratory tract, surgical site, skin soft tissue were dominant in HA-MRSA, skin soft tissue was dominant in CA-MRSA, and there was significant difference between HA-MRSA and respiratory tract infection, and the proportion of respiratory tract infection in community and nosocomial infection was higher. There were significant differences between the two groups in age, length of stay in hospital, whether or not ICU, was operated on, whether invasive operation was performed before infection, and so on. There were significant differences between the two groups in the treatment of rifampicin, gentamycin, moxifloxacin, and so on. The drug resistance rate of ciprofloxacin was higher than that of CA-MRSA (P0.05). 3) the infection rate of HA-MRSA in intensive care area was higher than that in common ward, the difference was statistically significant (P0.05). Respiratory tract infection (61.11%) and blood infection (27.78%) were the main diseases in the intensive care area, while in the common ward, the infection in the surgical site (47.22%) and the skin and soft tissue MRSA infection (19.44%). The proportion of nosocomial infection sites in different areas was different (P0.05). MRSA nosocomial infection patients in intensive care ward and general ward were different in age, basic disease, inserted operation, operation and disease outcome (P0.05). 4) A total of 121 samples were collected from air, various surfaces and workers' hands, and MRSA4 strains were cultured. The results of drug resistance analysis showed that the bacteria had high homology. Conclusion: 1) the monitoring of CA-MRSA should be strengthened to detect and control the source of infection and the carriers in the community in time, and the monitoring of HA-MRSA in the elderly and patients with risk factors of infection should be strengthened. Identify the risk of infection in time and take effective preventive measures; 2) there were differences in MRSA nosocomial infection between the intensive care area and the general ward. In the aspect of the prevention and control of MRSA nosocomial infection, the emphasis of the intensive care ward and the general ward should be different. 3) there is homology between the samples detected in the environment and the clinical specimens of the patients. There is a hidden danger of cross infection in the MRSA infection in our hospital, so the cleaning and disinfection of the surrounding environment of the patients with MRSA infection should be increased.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R446.5;R378.11
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