2024 年第 4 期 第 19 卷

骨折内固定术后感染金黄色葡萄球菌患者的耐药监测及临床分析

Drug resistance monitoring and clinical analysis of Staphylococcus aureus in patients with infection after fracture internal fixation

作者：季欧仲瑞雪刘小莉陈韵蓓郎志刚段小云

英文作者：Ji Ou Zhong Ruixue Liu Xiaoli Chen Yunbei Lang Zhigang Duan Xiaoyun

单位：四川省骨科医院药学部，成都610041

英文单位：Department of Pharmacy Sichuan Orthopaedic Hospital Chengdu 610041 China

关键词：金黄色葡萄球菌；骨折内固定术后感染；万古霉素；耐药性

英文关键词：Staphylococcusaureus;Infectionafterfractureinternalfixation;Vancomycin;Drugresistance

• 摘要：

• 目的 分析金黄色葡萄球菌在骨折内固定术后感染患者中的耐药情况。方法 回顾性分析四川省骨科医院2016年1月至2020年12月骨折内固定术后确诊为金黄色葡萄球菌感染的临床病例，共收集金黄色葡萄球菌467株。根据药物敏感性实验分为耐甲氧西林金黄色葡萄球菌（MRSA）组（145株）和甲氧西林敏感金黄色葡萄球菌（MSSA）组（322株），分析比较2组对常见抗菌药物的耐药情况。统计2016—2020年万古霉素对MRSA最低抑菌浓度（MIC）。结果 金黄色葡萄球菌对青霉素的耐药率达94.9%（443/467），对红霉素、克林霉素、苯唑西林、四环素耐药率较高，对左氧氟沙星、利福平、复方磺胺甲噁唑片、莫西沙星的耐药率较低［8.4%（39/467）、5.8%（27/467）、3.6%（17/467）、3.0%（14/467）］，未发现对万古霉素、利奈唑胺、达托霉素耐药的菌株，万古霉素中介3株。MRSA组和MSSA组对克林霉素、苯唑西林、红霉素、左氧氟沙星、莫西沙星、青霉素、利福平、复方磺胺甲噁唑片、四环素的耐药率比较差异均有统计学意义（均P＜0.05）。万古霉素对MRSA的MIC为2 mg/L的比例较高。结论 金黄色葡菌球菌引起的骨折内固定术后感染MRSA检出率较高，万古霉素MIC=2 mg/L的比例较高，降低了万古霉素治疗骨折内固定术后感染的达标率，且万古霉素骨组织渗透率不高，增加了临床治疗难度。因此万古霉素骨水泥植入，联合万古霉素静脉用药，或万古霉素静脉用药与利福平、喹诺酮类、磺胺类、利奈唑胺等联合用药可能是治疗骨折内固定术后感染的较好选择。

• Objective To study the drug resistance and clinical characteristics of patients with Staphylococcus aureus with infection after fracture internal fixation. Methods Retrospective analysis was conducted for the medical records of inpatients with infection after fracture internal fixation caused by Staphylococcus aureus from January 2016 to December 2020 in Sichuan Orthopaedic Hospital. Totally 467 strains of Staphylococcus aureus were recorded. According to the drug susceptibility experiment, it was divided into methicillin-resistant Staphylococcus aureus (MRSA) group (145 strains) and methicillin-sensitive Staphylococcus aureus (MSSA) group (322 strains), and the resistance of the two groups to common antibacterial drugs was analyzed and compared. The minimum inhibitory concentration (MIC) of vancomycin on MRSA from 2016 to 2020 was counted. Results The resistance rate of Staphylococcus aureus to penicillin was 94.9%(443/467), the resistance rates to erythromycin, clindamycin, oxacillin and tetracycline were high, and the resistance rates to levofloxacin, rifampicin, compound sulfamethoxazde tablets, and moxifloxacin were low ［8.4%(39/467), 5.8%(27/467), 3.6%(17/467), 3.0%(14/467)］, and no strains resistant to vancomycin, linezolid and daptomycin were found. Vancomycin mediated 3 strains. There were significant differences in the resistance rates between the MRSA group and the MSSA group for clindamycin, oxacillin, erythromycin, levofloxacin, moxifloxacin, penicillin, rifampicin, compound sulfamethoxazde tablets, and tetracycline (all P<0.05). Vancomycin had a high proportion of MRSA with MIC of 2 mg/L. Conclusions The detection rate of MRSA in fracture internal fixation caused by Staphylococcus aureus is high. The proportion of vancomycin with MIC=2 mg/L is high, which reduces the standard rate of vancomycin in the treatment of post fracture internal fixation infection, and the permeability of vancomycin bone tissue is not high. Those increase the difficulty of clinical treatment. Therefore, vancomycin bone cement implantation combined with intravenous medication, or vancomycin, rifampicin, quinolones, sulfonamides and other combined drugs may be a better choice for the treatment of postoperative infection after fracture internal fixation.