【摘要】：目的：調(diào)查本院耐甲氧西林金黃色葡萄球菌(MRSA)的感染患者的臨床特點(diǎn)及其耐藥情況,并對(duì)臨床標(biāo)本MRSA和環(huán)境微生物學(xué)監(jiān)測(cè)的MRSA進(jìn)行耐藥譜分析,探討同源性,為MRSA感染預(yù)防控制及治療提供確實(shí)可靠的依據(jù)。方法：采用回顧調(diào)查方法對(duì)MRSA感染患者相關(guān)臨床資料進(jìn)行統(tǒng)計(jì)分析,了解本院MRSA感染分布、耐藥情況；收集40例MRSA感染患者臨床標(biāo)本,并采集其對(duì)應(yīng)醫(yī)院環(huán)境微生物標(biāo)本,對(duì)陽(yáng)性標(biāo)本進(jìn)行藥敏實(shí)驗(yàn),對(duì)照藥敏譜分析其同源性。結(jié)果：1)在調(diào)查的71例MRSA患者中,男44人,女27人,平均年齡47.32±23.61歲,醫(yī)院獲得性耐甲氧西林金黃色葡萄球菌(HA-MRSA)54例(76.06%),HA-MRSA感染率為0.11%,社區(qū)獲得性耐甲氧西林金黃色葡萄球菌(CA-MRSA)17例(23.94%)；2) HA-MRSA以呼吸道、手術(shù)部位、皮膚軟組織為主,CA-MRSA以皮膚軟組織為主,和HA-MRSA存在明顯差異；呼吸道感染在社區(qū)和醫(yī)院感染中比例均較高。兩者在年齡、住院天數(shù)、是否住ICU、是否手術(shù)、感染前是否進(jìn)行侵入性操作等作等方面存在明顯差異,HA-MRSA對(duì)利福平、慶大霉素、莫西沙星、環(huán)丙沙星的耐藥性率高于CA-MRSA (P0.05);3) HA-MRSA感染率重癥監(jiān)護(hù)病區(qū)高于普通病區(qū),二者差別有統(tǒng)計(jì)學(xué)意義(P0.05)；重癥監(jiān)護(hù)病區(qū)以呼吸道感染(61.11%)和血液感染(27.78%)為主,而普通病區(qū)以手術(shù)部位感染(47.22%)和皮膚軟組織MRSA感染(19.44%)為主,不同病區(qū)醫(yī)院感染部位構(gòu)成比有差異(P0.05)；重癥監(jiān)護(hù)病區(qū)和普通病區(qū)MRSA院內(nèi)感染患者在年齡、基礎(chǔ)疾病、插入性操作、手術(shù)、疾病轉(zhuǎn)歸方面均存在差異(P0.05)；4)采集環(huán)境中空氣、各類(lèi)表面、工作人員手共121份標(biāo)本,培養(yǎng)出MRSA4株,通過(guò)耐藥譜分析顯示細(xì)菌具有高度同源性。結(jié)論：1)應(yīng)加強(qiáng)對(duì)CA-MRSA監(jiān)測(cè),及時(shí)發(fā)現(xiàn)并通過(guò)隔離等措施控制社區(qū)感染源和帶菌者,應(yīng)加強(qiáng)對(duì)老年人及具有感染危險(xiǎn)因素患者的HA-MRSA監(jiān)測(cè),及時(shí)發(fā)現(xiàn)感染風(fēng)險(xiǎn)并采取有效的預(yù)防措施；2)重癥監(jiān)護(hù)區(qū)和普通病區(qū)MRSA院內(nèi)感染存在差異,在MRSA醫(yī)院感染預(yù)防與控制方面,重癥監(jiān)護(hù)病區(qū)和普通病區(qū)側(cè)重點(diǎn)應(yīng)當(dāng)有所不同；3)環(huán)境中檢出的標(biāo)本和患者臨床標(biāo)本存在同源性,在我院MRSA感染存在交叉感染的隱患,應(yīng)加大MRSA感染患者周?chē)h(huán)境的清潔與消毒工作。
[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 鹵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.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R446.5;R378.11

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