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目的:探讨我院儿童社区获得性肺炎(CAP)耐甲氧西林金黄色葡萄球菌(MRSA)的耐药性,分析呼吸道定植危险因素。方法:采用回顾性研究方法,从2012-2014年在我院住院的CAP患儿中选取痰培养检出金黄色葡萄球菌(SA)的患儿692例,根据药敏试验结果将692株SA分为社区获得性甲氧西林敏感金黄色葡萄球菌(CA-MSSA)和社区获得性MRSA(CA-MRSA)两组,检测分析SA对常用抗菌药物的耐药率,并采用Logistic回归分析方法从性别、年龄、发病地点、抗菌药物使用时间等方面分析MRSA呼吸道定植的危险因素。结果:2012-2014年我院SA检出率为7.23%(692/9 569),692株SA中MRSA 226株(32.66%)。CA-MSSA对红霉素、阿奇霉素耐药率较高;CA-MRSA对青霉素类、头孢菌素类基本耐药,对亚胺培南、阿奇霉素及克林霉素部分耐药,对利福平、复方磺胺甲唑及左氧氟沙星的耐药率较低,对万古霉素未产生耐药。CA-MRSA对常用抗菌药物的耐药率均高于CA-MSSA(P均<0.05)。低龄(<3岁)、在农村发病、长时间使用抗生素(≥7 d)是CA-MRSA定植的危险因素。结论:基层医疗机构规范使用抗生素对控制CA-MRSA定植与感染有重要意义。我们在临床工作中应加强具有高危因素患儿的管理,及时完善细菌学检查,合理选用抗菌药物。
Objective: To investigate the drug resistance of children with community-acquired pneumonia (CAP) methicillin-resistant Staphylococcus aureus (MRSA) in our hospital and to analyze the risk factors of respiratory colonization. Methods: A retrospective study was conducted to select 692 children with CAP-infected S. aureus (SA) from 2012 to 2014 in our hospital. According to the results of susceptibility test, 692 SA patients (CA-MSSA) and community-acquired MRSA (CA-MRSA) were detected and analyzed. The drug resistance rates of SA to common antimicrobial agents were detected and analyzed by Logistic regression analysis. , Age, place of onset, antibacterial drug use time and other aspects of MRSA respiratory tract colonization risk factors. Results: The detection rate of SA in our hospital was 7.23% (692/9 569) between 2012 and 2014, and 226 (32.66%) of MRSA in 692 SA patients. CA-MSSA showed high resistance rates to erythromycin and azithromycin. CA-MRSA was resistant to penicillins and cephalosporins, partially resistant to imipenem, azithromycin and clindamycin, , The compound sulfamethoxazole and levofloxacin resistance rate is low, no resistance to vancomycin. The resistance rate of CA-MRSA to commonly used antibiotics was higher than that of CA-MSSA (all P <0.05). Older age (<3 years), onset in rural areas, long-term use of antibiotics (≥ 7 d) is a risk factor for CA-MRSA colonization. Conclusion: The standard use of antibiotics in primary medical institutions is of great significance in controlling the colonization and infection of CA-MRSA. We should strengthen the management of children with high-risk factors in clinical work, improve bacteriological examination in time, and make rational use of anti-bacterial drugs.