从尼泊尔山区的一家三级保健教学医院的临床标本中分离出的耐甲氧西林金黄色葡萄球菌的流行情况、抗菌药物敏感性模式和多药耐药性：一项观察性、横断面研究。
Prevalence, antimicrobial susceptibility pattern and multidrug resistance of methicillin-resistant isolated from clinical samples at a tertiary care teaching hospital: an observational, cross-sectional study from the Himalayan country, Nepal.
机构信息
Department of Pharmacy, Maharajgunj Medical Campus (MMC), Institute of Medicine (IOM), Tribhuvan University, Kathmandu, Bagmati, Nepal.
Department of Clinical Microbiology, Tribhuvan University Institute of Medicine Maharajgunj Medical Campus, Kathmandu, Bagmati, Nepal.
出版信息
BMJ Open. 2023 May 10;13(5):e067384. doi: 10.1136/bmjopen-2022-067384.
OBJECTIVE
We sought to determine the prevalence and antimicrobial susceptibility pattern of methicillin-resistant (MRSA) isolated from the clinical samples at a tertiary care hospital in Nepal.
METHODS
Cross-sectional, observational study design.
STUDY SETTING
The study was carried out at a tertiary care facility, the largest public hospital, Tribhuvan University Teaching Hospital (TUTH), Nepal.
PARTICIPANTS
A total of 7433 clinical samples from hospital inpatients and outpatients available in the TUTH microbiology laboratory were examined. The study included clinical samples from the patients of either sex and across all age groups that had been clinically determined to have infections.
RESULTS
Of 7433 clinical samples analysed, was recovered from 499 (6.71%). The prevalence of MRSA was discovered to be 26.4% (95% CI 21.6% to 30.4%). The major sources of MRSA were pus, 71 (18.5%). MRSA isolates encountered 100% resistance to penicillin and cloxacillin, followed by ciprofloxacin (80.5%), erythromycin (79.8%), cephalexin (64.9%), cotrimoxazole (61.1%) and clindamycin (58.5%). Chloramphenicol (17.9%), and gentamicin (27.4%), on the other hand, exhibited minimal resistance. None of the isolates were resistant to vancomycin (0.0%). Prevalence of multidrug resistance (MDR) was markedly higher in MRSA, 94.05% (95% CI 89.4% to 98.6%), compared with methicillin-sensitive , 52.12% (95% CI 46.2% to 57.8%).
CONCLUSION
Our study indicated a high rate of MRSA and MDR-SA (Multidrug-resistant Staphylococcus aureus) prevalence in a Nepalese tertiary care hospital. Therefore, given the widespread burden of MRSA and the threat of the emergence of resistance to commonly used antibiotics, there is a need for the development, adoption and enforcement of appropriate control policies in these hospital settings. Regular surveillance, reporting mechanism as well as prudent use of antimicrobial agents are crucial to combating the progression of MDR-MRSA prevalence and antibiotic resistance.
目的
我们旨在确定尼泊尔一家三级保健医院从临床标本中分离出的耐甲氧西林金黄色葡萄球菌（MRSA）的流行率和抗生素敏感性模式。
方法
横断面、观察性研究设计。
研究地点
这项研究在一家三级保健机构、最大的公立医院特里布万大学教学医院（TUTH）进行。
参与者
共有 7433 份来自 TUTH 微生物实验室住院和门诊患者的临床样本进行了检查。该研究包括来自任何性别和所有年龄组的临床确定患有感染的患者的临床样本。
结果
在分析的 7433 份临床样本中，从 499 份（6.71%）中分离出。MRSA 的患病率被发现为 26.4%（95%CI 21.6%至 30.4%）。MRSA 的主要来源是脓液，为 71 例（18.5%）。MRSA 分离株对青霉素和氯唑西林完全耐药，其次是环丙沙星（80.5%）、红霉素（79.8%）、头孢氨苄（64.9%）、复方磺胺甲噁唑（61.1%）和克林霉素（58.5%）。另一方面，氯霉素（17.9%）和庆大霉素（27.4%）显示出最小的耐药性。所有分离株均对万古霉素（0.0%）无耐药性。与甲氧西林敏感的金黄色葡萄球菌相比，耐甲氧西林金黄色葡萄球菌（MRSA）的多重耐药性（MDR）发生率明显更高，为 94.05%（95%CI 89.4%至 98.6%），而甲氧西林敏感的金黄色葡萄球菌为 52.12%（95%CI 46.2%至 57.8%）。
结论
我们的研究表明，在尼泊尔的一家三级保健医院中，耐甲氧西林金黄色葡萄球菌（MRSA）和耐多药金黄色葡萄球菌（MDR-SA）的流行率很高。因此，鉴于 MRSA 的广泛负担以及对常用抗生素产生耐药性的威胁，需要在这些医院环境中制定、采用和执行适当的控制政策。定期监测、报告机制以及谨慎使用抗菌药物对于控制 MDR-MRSA 流行率和抗生素耐药性的发展至关重要。
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