骨科患者医院感染与社区感染金黄色葡萄球菌的耐药性分析

目的 比较医院骨科感染与社区感染金黄色葡萄球菌的耐药性，了解骨科患者感染金黄色葡萄球菌的药敏变化，分析其耐药性差异及原因，为临床合理选用抗菌药物提供参考。方法 对贵州医科大学第三附属医院骨科2010年1月至2015年12月各类临床标本中分离出的金黄色葡萄球菌139株进行分析，样本区分医院感染和社区感染，对二者进行比较分析。病原菌鉴定采用VITEK-32微生物分析系统，药敏试验采用K-B纸片法，统计分析使用SPSS 19.0软件。结果 骨科患者医院感染金黄色葡萄球菌检出率为19.76%，社区感染检出率为10.76%，医院感染患者检出率高于社区感染患者（2=8.10，P=0.004）。两种患者所检出的金黄色葡萄球菌对万古霉素（0.77%）、阿米卡星（1.96%）、利福平（4.19%）、替考拉宁（2.16 %）、米诺环素（0.00%）和利奈唑胺（0.00%）等11种抗菌药物耐药率较低, 可作为治疗的首选药。医院感染与社区感染的金黄色葡萄球菌对苯唑西林、头孢唑林、阿莫西林/克拉维酸、克林霉素、红霉素、阿奇霉素、庆大霉素、氧氟沙星、呋喃妥因、复方新诺明、罗红霉素、吗啉噁酮、奎奴普汀/达福普汀等17种抗菌药物的耐药率分别为70.97%、20.22%，50.00%、15.79%，50.00%、9.62%，53.13%、23.66%，82.76%、43.01%，83.33%、38.30%，22.22%、3.95%，19.05%、6.78%，21.74%、7.81%，41.38%、17.50%，66.67%、30.77%，14.29%、0.00 %，14.29%、0.00%，医院感染金黄色葡萄球菌的耐药性高于社区感染的，差异具有统计学意义（P<0.05）。结论 骨科医院感染患者金黄色葡萄球菌感染率和耐药率均高于社区感染患者，制订治疗方案时应区别医院感染与社区感染，合理使用抗菌药物，从而减少抗菌药物的滥用和细菌耐药性的产生。

Drug resistance of Staphylococcus aureus in hospital infections vs community infections in department of orthopedics

Objective To compare the drug resistance of Staphylococcus aureus in the department of orthopedics between hospital infections and community infections, explore the change, difference and cause of the pathogen’s resistance, and provide reference for rational use of antimicrobial agents. Methods 139 strains of Staphylococcus aureus isolated from the orthopedics department during January 2010 and December 2015 were divided into community infection group or hospital infection group. The identification of pathogenic bacteria was performed by using Vitek-32 microbial analysis system, drug susceptibility test by using K-B method, and data analysis by using SPSS 19.0. The results were compared between the two groups. Results The detection rate of Staphylococcus aureus was 19.76% in hospital infection group, significantly higher than the 10.76% in community infection group (2=8.10, P=0.004). The resistance rates to Vancomycin (0.77%), Amikacin (1.96%), Rifampicin (4.19%), Teicoplanin (2.16%), Minocycline (0.00%), Linezolid (0.00%) and other 11 antimicrobial drugs were low. The resistance rates of the pathogen in hospital infections to 17 antibacterial drugs including Oxacillin, Cefazolin, Amoxicillin/clavulanic acid, Clindamycin, Gentamicin, Erythromycin, Azithromycin, Ofloxacin, Nitrofurantoin, Cotrimoxazole, Roxithromycin, Linezolid and Quinupristin/dalfopristin were significantly higher than those of the pathogen in community infections (P<0.05). Conclusion The infection rate and drug resistance rate of Staphylococcus aureus are higher in patients with hospital infections than in those with community infections, which should be taken into consideration in the treatment. Antimicrobial drugs should be used rationally to reduce the appearance of resistant strains.