The Analysis Of MRSA Infection, Prevalence And Treatment Of Vancomycin In Hospital

Objective : Surveying the prevalence, resistance and use of antibiotic in MRSA patients in our hospital; Evaluating vancomycin serum concentration monitoring and relationship between its associsted PK/PD parameters and clinical efficacy, exploring rational clinical treatment programes.Methods: Analysing patients'clinical data caused by MRSA in order to master the distribution, infection risk factors and antibiotics-use; Typing 161 MRSA strains in order to understand their origin and background; Using HPLC to measure vancomycin plasma concentration in MRSA pneumonia patients, in order to explore the relationship between its relevant PK/PD parameters and clinical efficacy.Results: (1) In the 161 patients infected with MRSA, male is more than female significantly,male:female=1.73:1,older people is the susceptible population. In various specimens, sputum, secretions and drainage of fluid samples are the highest,respectively 50.93%, 14.29% and 7.45%. In different departments, the cadre ward, ICU and neurology departments are important departments。(2) All MRSA strains were susceptible to vancomycin , quinupristin/dalfopristin and linezolid,The resistant rate of antibiotics are different。The major SCCmec types are SCCmecII and SCCmecIII.(3)The use of antibiotics is not quite rational with MRSA patients in hospital,especially to abuse third-generation cephalosporins,fluoroquinolones and other broad-spectrum antimicrobial before the diagnosis of MRSA.(4)The monitoring of vancomycin serum concentration shows: drug plasma concentration is increased,its elimination is slow in the elder in vivo;The Cmax and treatment efficacy of vancomycin are associated,the highter of the Cmax,the better of the efficacy,and the days of using vancomycin is short;The linear correlation between vancomycin trough concentrations and the changes in Scr, the higher the trough concentration, the more easily triggered nephrotoxicity;(5)The parameters with vancomycin-related clinical efficacy are AUC/MIC, Cmax/MIC and MIC.Conclusion: (1) The MRSA monitoring should be strengthened on the elder, key-department and patients with risk factors,in order to find infected patientsand carriers in time. (2)The mainly SCCmec types are III and II type,their resistance-rate are high.The relevant control measures should be strengthened. (3) The use of antibiotics is not quite rational with MRSA patients in hospital. We should strictly abide relevant provisions of the clinical antibiotics application.(4) Vancomycin metabolism is difference individually in vivo,can affect clinical efficacy and easy to cause kidney toxicity and other adverse reaction,we should enhance to monitore vancomycin concentration in plasma.