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[目的]了解某院医院获得性耐甲氧西林金黄色葡萄球菌(HA-MRSA)和社区获得性耐甲氧西林金黄色葡萄球菌(CA-MRSA)感染/定植情况,研究其临床分布和耐药特征有何不同。[方法]采用前瞻性队列研究,对每个新分离出耐甲氧西林金黄色葡萄球菌(MRSA)的病人均进行调查,收集患者人口学资料和临床资料。每株分离菌均进行药敏试验。[结果]监测期间共发现MRSA感染/定植281例,其中医院获得性MRSA243例(86.5%),社区获得性MRSA38例(13.5%);与CA-MRSA感染/定植患者相比,HA-MRSA的住院时间明显延长(P=0.000),并且多为肺部感染(P=0.001),而CA-MRSA患者的皮肤软组织感染则明显多于HA-MRSA患者(P=0.001);虽然CA-MRSA对环丙沙星、庆大霉素和利福平的敏感性明显高于HA-MRSA,但仍低于30%,所有MRSA仅对万古霉素、复方新诺明、呋喃妥英具有较高的敏感性。[结论]HA-MRSA和CA-MRSA具有不同的临床特征和微生物特征,其耐药情况已十分严重,特别是HA-MRSA,应加强MRSA的预防和控制,特别是HA-MRSA的预防控制,降低MRSA的耐药率及医院感染流行的出现。
[Objective] To investigate the infection and colonization of acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) and community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in a hospital and study its clinical distribution and resistance What are the differences in drug characteristics? [Methods] A prospective cohort study was conducted in each of the newly isolated patients with methicillin-resistant Staphylococcus aureus (MRSA) to collect demographic data and clinical data. Each isolates were susceptible to drug testing. [Results] A total of 281 cases of MRSA infection / colonization were found during the surveillance period, of which 243 (86.5%) were hospital-acquired MRSA and 38 (13.5%) were community-acquired MRSA. Compared with patients with CA-MRSA infection / colonization Hospitalization was significantly prolonged (P = 0.000) and was mostly pulmonary (P = 0.001), whereas skin and soft tissue infections were significantly more frequent in patients with CA-MRSA than in patients with HA-MRSA (P = 0.001); although CA-MRSA versus Ciprofloxacin, gentamicin and rifampin sensitivity was significantly higher than HA-MRSA, but still less than 30%, all MRSA only vancomycin, cotrimoxazole, nitrofurantoin have a higher Sensitivity. [Conclusion] HA-MRSA and CA-MRSA have different clinical features and microbial characteristics, and their drug resistance has been very serious. In particular, HA-MRSA should be strengthened to prevent and control MRSA, especially prevention and control of HA-MRSA. Reduce the rate of MRSA resistance and the emergence of nosocomial infection.