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目的调查2014—2015年郑州人民医院重症监护病房中耐甲氧西林金黄色葡萄球菌(MRSA)的分子流行病学分布,耐药性特征及感染危险因素。方法采用葡萄球菌蛋白A基因(spa)分型技术对53株MRSA进行分子流行病学研究,并进行17种抗菌药物的药敏试验。然后采用1:2成组病例对照方法选取同时期苯唑西林敏感金黄色葡萄球菌感染患者作为对照组,对MRSA感染危险因素进行分析。结果 53株MRSA的分子克隆型全部为t-030。MRSA敏感性最高的抗菌药物为万古霉素,替考拉宁,甲氧苄啶和复方新诺明(100%)。Logistic回归分析显示,重症监护病房(ICU)中心静脉置管和气管插管是MRSA感染的独立危险因素。结论重症监护病房MRSA克隆株由t-030引起,这与之前在郑州人民医院呼吸肿瘤病房的研究一致。MRSA耐药性强,中心静脉置管和气管插管等有创性治疗是MRSA感染的独立危险因素,加强对这些独立危险因素的控制可有效预防其感染扩散。
Objective To investigate the molecular epidemiological distribution, drug resistance and risk factors of methicillin-resistant Staphylococcus aureus (MRSA) in the ICU of Zhengzhou People’s Hospital from 2014 to 2015. Methods Staphylococcal protein A gene (spa) typing technique was used to conduct molecular epidemiological studies on 53 strains of MRSA and antibiotic susceptibility test of 17 kinds of antibiotics. Then 1: 2 group case-control method was used to select the same period of oxacillin-sensitive Staphylococcus aureus infection as a control group, the risk factors for MRSA infection were analyzed. Results The molecular clonotypes of 53 strains of MRSA were all t-030. The most sensitive antimicrobial agents for MRSA were vancomycin, teicoplanin, trimethoprim and cotrimoxazole (100%). Logistic regression analysis showed that central venous catheterization and endotracheal intubation in ICU were independent risk factors for MRSA infection. Conclusion The MRSA clone in the intensive care unit was caused by t-030, consistent with the previous study of respiratory tumor ward at Zhengzhou People’s Hospital. MRSA resistance, invasive central catheter and endotracheal intubation and other invasive treatment of MRSA infection is an independent risk factor, to strengthen the control of these independent risk factors can effectively prevent the spread of infection.