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目的观察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,研究呼吸道定植危险因素。方法利用回顾性分析法对医院收治的367例金黄葡萄球菌(SA)患儿进行研究,按照药敏试验结果划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(即CA-MRSA)各个组别,对常用的抗菌药物的耐药率进行检测和分析,并利用Logistic回归法,从年龄、性别、发病地点和抗菌药物使用时间等因素,对MRSA呼吸道定植的危险因素进行分析。结果医院内部检验出SA为367株,检出率为7.72%(367/4 756)。在367株SA中,CA-MRSA为142株,占比38.69%,而CA-MSSA为225株,占比61.31%。CA-MRSA对青霉素和头孢菌霉素属于基本耐药;对亚胺培南、克林霉素、阿奇霉素部分耐药;对于利福平、左氧氟沙星的耐药性较低。而万古霉素不存在耐药性。在对其耐药性研究中得知,CA-MSSA对一般的抗菌药物的耐药性低于CA-MRSA(P<0.01)。年龄<4岁、发病地点在农村、抗生素使用时间≥6 d,属于CA-MRSA的定植危险因素。结论在医疗机构基层规范运用抗生素,注重对高危因素小儿患者的管理,注重对细菌学检查的完善,并对抗菌药物予以合理选用。
Objective To investigate the drug resistance of children with community-acquired pneumonia (CAP) methicillin-resistant Staphylococcus aureus (MRSA) and to study the risk factors of respiratory colonization. Methods A retrospective analysis of 367 patients with Staphylococcus aureus (SA) admitted to the hospital was conducted and divided into community-acquired methicillin-susceptible Staphylococcus aureus (CA-MSSA) and community-acquired MRSA (CA-MRSA) in each group, commonly used antimicrobial resistance rates were detected and analyzed, and the use of Logistic regression method, from age, gender, place of incidence and antibiotic use time and other factors, MRSA respiratory colonization The risk factors were analyzed. Results There were 367 strains of SA in the hospital, the detection rate was 7.72% (367/4 756). Among 367 strains of SA, 142 were CA-MRSA, accounting for 38.69%, while CA-MSSA was 225, accounting for 61.31%. CA-MRSA is basically resistant to penicillin and cephalosporin; partly resistant to imipenem, clindamycin and azithromycin; and less resistant to rifampicin and levofloxacin. Vancomycin is not resistant. In its resistance study, CA-MSSA showed less resistance to common antimicrobial agents than CA-MRSA (P <0.01). Age <4 years old, the incidence of the disease in rural areas, the use of antibiotics ≥ 6 d, are CA-MRSA colonization risk factors. Conclusion The use of antibiotics at the grassroots level in medical institutions pays attention to the management of pediatric patients with high risk factors, pays attention to the improvement of bacteriological examination, and makes rational use of antimicrobial agents.