The Distribution Of MRSA Infection In Hospitals And Evaluation Of The Effects Of Three Commanly Used Anti-MRSA Drugs On MRSA Pneumonia

Objective: The first aim of this study is to analyze the current distribution of MRSA in our city via investigating the prevalence and drug resistance of methicillin-resistant Staphylococcus aureus(MRSA)in different departments of three hospitals(Weifang Yidu Central Hospital,Qingzhou people's Hospital and Qingzhou maternal and child health hospital)in Qingzhou District,Shandong Province.The second aim of the study is to provide some guidance for clinicians on how to effectively treat MRSA pneumonia through retrospectively analyzing the clinical efficacy and safety of vancomycin,linezolid and teicoplanin in the treatment of MRSA pneumonia in three hospitals.Methods: The positive strains of MRSA in the inpatients that reported to infection management department of three hospitals(Weifang Yidu Central Hospital,Qingzhou people's Hospital and Qingzhou maternal and child health care hospital)from January 2016 to December 2019 in Qingzhou City,Shandong Province were collected.The types of positive strains,Department sources,drug resistance,nosocomial infection rate of above MRSA samples and the prevalence of MRSA infection were analyzed to evaluate the prevalence of MRSA in above three hospitals of our city.After collecting the complete medical records of MRSA pneumonia patients,we divided them into three groups according to different medication conditions: vancomycin group,linezolid group and teicoplanin group.The clinical symptoms,positive signs,auxiliary examination results and bacterial culture of the patients before and after treatment were statistically analyzed.Furthermore,we analyzed the clinical efficiency,bacterial clearance rate and adverse drug effects to evaluate the clinical efficacy and safety of three drugs in the treatment of MRSA pneumonia.Results:During the statistical period,557 MRSA positive specimens were collected from inpatients in our city,and 1,177 MRSA positive specimens were collected from the same period.MRSA accounted for a high proportion in Staphylococcus aureus,accounting for 51.1% in 2016,47.4% in 2017,47.1% in 2018,43.6% in 2019;sputum was the main type of specimens,a total of 315 strains(56.5%),86 strains in blood(15.4%),62 strains in secretion(11.1%),48 strains in puncture fluid(8.6%),16 strains in alveolar lavage fluid(2.8%),16 strains in urine(2.8%)2.8%)and 14 others(2.5%).Among the 557 MRSA positive strains,the drug resistance rate to penicillin,erythromycin and clindamycin was more than 90%,and to rifampin,gentamycin and levofloxacin,etc.there was no drug resistance to vancomycin,linezolid and teicoplanin.Most of the cases of MRSA infection were male(male to female ratio 1.5:1).There were 208 patients with HA-MRSA and 265 patients with CA-MRSA.The nosocomial infection rate of MRSA was 43.9%.MRSA infection occurred in respiratory tract,followed by surgical infection,skin and soft tissueinfection.2.121 patients with MRSA pneumonia were included in the study.According to their medication,they were divided into vancomycin group(57 cases),linezolid group(38cases)and teicoplanin group(26 cases).Clinical effective rate: vancomycin 47.37%,linezolid 68.42%,teicoplanin 42.31%.The bacterial clearance rate was 42.10%,65.79% and34.62% respectively.The clinical effective rate and bacterial clearance rate of linezolid group were significantly higher than those of vancomycin group and teicoplanin group(P <0.05).There was no significant difference between vancomycin group and teicoplanin group(P > 0.05).The incidence of adverse reactions was 15.38%,13.1% and 15.38% respectively.There was no significant difference among the three groups(P > 0.05).Conlusion:MRSA is still one of the important pathogens of nosocomial infection in our city.It is highly resistant to ?-lactam,macrolides,quinolones,aminoglycosides and clindamycin.Therefore,these are not recommended as an empirical drug for the treatment of MRSA infection.2.The drug resistance rate of Compound Sulfamethoxazole is relatively low,so it can be used in clinic as appropriate,but the clinical effect should be evaluated in time,and the antibiotics should be adjusted in time according to the relevant drug sensitivity test if necessary.At present,vancomycin,linezolid and teicoplanin are all sensitive to MRSA,which can be used as the first-line drug in clinical MRSA treatment.2.ICU,neurosurgery and general surgery are the departments with high incidence of infection in MRSA in above three Hospitals of our city.The elderly patients who are repeatedly hospitalized,weak in physique and have invasive operations recently are the susceptible population of MRSA.Respiratory tract is the main infection site of MRSA.Clinicians should focus on the supervision of key departments,high-risk groups and high-risk factors;standardize the aseptic operation process,take effective isolation and disinfection measures in time,pay attention to health education,and avoid the outbreak or prevalence of MRSA in hospital.3.The incidence of adverse reactions of the three drugs is low,and the safety of clinical medication is good.Among them,Linezolid is superior to vancomycin and teicoplanin in the treatment of MRSA pneumonia.