慢性鼻窦炎耐甲氧西林葡萄球菌对抗生素耐药分析.doc

慢性鼻窦炎耐甲氧西林葡萄球菌对抗生素耐药分析 　【摘要】 了解慢性鼻窦炎耐甲氧西林葡萄球菌(methicillin resistant staphylococcus， MRS)的感染情况及耐药特点，为临床合理选用抗菌药物、有效控制MRS的感染提供依据。方法：　采用苯唑青霉素纸片法和琼脂筛选法，对临床分离的葡萄球菌行MRS检测，并测定了它们对20种常用抗生素的耐药谱和β内酰胺酶。结果：　72株金黄色葡萄球菌中，耐甲氧西林株占37.6%，其中产β内酰胺酶菌株占77.8%。凝固酶阴性的葡萄球菌(CoN葡菌)中，耐甲氧西林株占38.3%，其中产β内酰胺酶菌株占72.7%。MRS菌株耐药程度明显高于甲氧西林敏感葡萄球菌（Plt;0.05）。金黄色葡萄球菌耐甲氧西林株和凝固酶阴性葡萄球菌耐甲氧西林株多重耐药数分别为6 17种和5 15种。结论：万古霉素、利福平、丁胺卡那对MRS显示了较强的抗菌活性。万古霉素是治疗感染的首选药物，MRS的多重耐药性应引起广泛关注，需加强抗生素使用的管理和MRS对抗生素耐药性的监测。 【关键词】 鼻窦炎 甲氧西林耐药 葡萄球菌属 抗生素类 To investigate the infective rate of methicillinresistant staphylococcus(MRS) and its resistance characteristics so as to provide a basis for the clinically rational use of antimicrobial agents and an effective control of MRS infections. Methods:　Strains of staphylococcus from clinical samples were determined by a disc agar diffusion method and MRS agar plate screening. At the same time their resistance to 20 different antimicrobial agents and the presence of βlactamase in the strains were determined. Results： Twentyseven strains of MRSA and thirtythree strains of MRSCoN were identified. The proportion of MRSA and MRSCoN was 37.6% and 38.3%, respectively. The incidence of MRSA and MRSCoN producing βlactamase was 77.8% and 72.7% ,respectively. The resistance rate showed a significant difference between the MRS and the MSS(Plt;0.05).The multiresistance ranged from 6 to 17 and 5 to 15 antibiotics in MRSA and MRSCoN. Conclusions: Vancomycin, Rifampin and Amikacin have effective antibacterial activity against MRS. Vancomycin is the first choice for MRS infections. Wide attention should be paid to the multiresistance of MRS, and the use of antibiotics should be better managed and the resistance of MRS to antibiotics should be further monitored. ［KEY WORDS］ Chronic nasosinusitis; Methicillin resistance;　　Staphylococcus;　Antibiotics 鼻窦炎是常见病、多发病，临床上有急性、亚急性、慢性、急性复发性、慢性急性发作性等类型，各型发病机制并非完全相同，尤其是对于慢性鼻窦炎。 耐甲氧西林葡萄球菌(methicillinresistant staph ylococcus， MRS)引起的感染已遍及世界各国，成为目前医院感染的重要致病菌。M