太原市老年人社区获得性金黄色葡萄球菌的流行病学特征调查

杨晓文; 张燕军; 彭盼; 李雪; 张沁莲; 刘晋平; 张建梅; 李临平

doi:10.16766/j.cnki.issn.1674-4152.002989

太原市老年人社区获得性金黄色葡萄球菌的流行病学特征调查

doi: 10.16766/j.cnki.issn.1674-4152.002989

1.
山西省人民医院感染管理科, 山西太原 030012
2.
山西省人民医院检验科, 山西太原 030012
3.
山西省人民医院信息管理处, 山西太原 030012

基金项目:

山西省卫生计生委科研项目 2018GW08

详细信息

通讯作者:
李临平，E-mail：linping902@126.com

中图分类号: R378.11 R181.2
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出版历程
- 收稿日期: 2022-04-28

Epidemiological characteristics survey of community acquired Staphylococcus aureus towards elderly in Taiyuan City

1.
Department of Hospital-infection Control, Shanxi Provincial People ' s Hospital, Taiyuan, Shanxi 030012, China

摘要

摘要: 目的由于受基础疾病、生活习惯及传统观念等因素影响，老年人群社区获得性金黄色葡萄球菌流行具有一定的特点。本研究通过调查太原市老年人群社区获得性金黄色葡萄球菌的流行病学特征，以期为老年人群开展针对性健康教育及临床治疗经验性用药提供科学依据。方法 2019年4月—2020年7月，抽取太原市4个行政区域的9个成熟社区，对年龄≥60岁的626名老年人进行问卷调查与病原学检测。采用χ²检验、Kruskal-Wallis H检验和logistic回归模型分析研究社区老年人群金黄色葡萄球菌(SA)与社区获得性耐甲氧西林金黄色葡萄球菌(community-acquired methicillin-resistant Staphylococcus aureus，CA-MRSA)携带情况及相关危险因素。结果 626名社区老年人中有35名携带SA，携带率为5.6%，其中，5人携带CA-MRSA，携带率为0.8%。基础疾病数量(χ²=9.229，P=0.026)、家庭结构(χ²=5.746，P=0.017)、是否吃隔夜饭(χ²=4.990，P=0.025)、近3个月是否使用抗菌药物(χ²=4.705，P=0.030)组间SA携带率差异有统计学意义。多因素分析显示，社区老年人群SA携带的影响因素有家庭结构(OR=2.523，95% CI：1.235~5.155，P=0.011)，吃隔夜饭(OR=2.496，95% CI：1.105~5.634，P=0.028), 近3个月是否使用抗菌药物(OR=2.394，95% CI：1.019~5.620，P=0.045)。结论太原市老年人群SA携带情况已与医疗机构老年患者SA携带水平相当，CA-MRSA携带水平低于全国平均水平，应持续加强社区老年人群健康宣教与抗菌药物管理，关注老年人群健康。
- 老年人 /
- 流行病学特征 /
- 金黄色葡萄球菌 /
- 社区获得性耐甲氧西林金黄色葡萄球菌
Abstract: Objective Due to the influence of underlying diseases, living habits and traditional ideas, the prevalence of community-acquired Staphylococcus aureus in elderly has certain characteristics. To investigate the epidemiological characteristics of community-acquired Staphylococcus aureus towards the elderly in Taiyuan, so as to provide evidence for health education and clinical the empirical use of antibacterial agents. Methods A total of 626 residents aged 60 years or older were selected from nine communities of four administrative regions in Taiyuan for face to face questionnaire survey and pathogenic detection from April 2019 to July 2020. Chi square test, Kruskal-Wallis H test and logistic regression model were used to analyze the carrying status and related risk factors of Staphylococcus aureus (SA) and community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in the elderly population in the community. Results Among the 626 elderly people in the community, 35 carried SA, with a carrying rate of 5.6%, of which 5 carried CA-MRSA, with a carrying rate of 0.8%. There was statistically significant difference in SA carrier rate in number of underlying diseases (χ²=9.229, P=0.026), family structure (χ²=5.746, P=0.017), whether to eat overnight meal (χ²=4.990, P=0.025), whether to use antibacterial drugs in the past 3 months (χ²=4.705, P=0.030). Multivariate logistics analysis showed that family structure (OR=2.523, 95% CI: 1.235-5.155, P=0.011), eating leftover (OR=2.496, 95% CI: 1.105-5.634, P=0.028), using of antibiotic in recently three month (OR=2.394, 95% CI: 1.019-5.620, P=0.045) were influencing factors of SA carrying. Conclusion The SA carrying level of the elderly population in Taiyuan is comparable to that of the elderly patients in medical institutions, and the CA-MRSA carrying level is lower than the national average. It is necessary to further strengthen the promotion of health education and antimicrobial management.
- Elderly /
- Epidemiological characteristics /
- Staphylococcus aureus /
- Community-acquired methicillin-resistant staphylococcus aureus
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表 1 金黄色葡萄球菌对常见抗菌药物的耐药情况

Table 1. Resistance of Staphylococcus aureus tocommon antimicrobial drugs

抗菌药物	耐药(株)	中介(株)	敏感(株)	耐药率(%)
青霉素	35	0	0	100.0
红霉素	20	0	15	57.1
克林霉素	7	0	28	20.0
利奈唑胺	0	0	35	0
苯唑西林	31	0	4	88.6
头孢西丁	5	0	30	14.3
庆大霉素	2	1	32	5.7
左氧氟沙星	2	0	33	5.7

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表 2 不同特征老年人群SA与CA-MRSA定植的单因素分析

Table 2. Univariate analysis of SA and CA-MRSA in the elderly with different characteristics

项目	类别	例数	SA定植[例(%)]	统计量	P值	CA-MRSA定植[例(%)]	统计量	P值
性别	男性	255	19(7.5)	2.820^a	0.093	3(1.2)	0.179^a	0.672
	女性	371	16(4.3)			2(0.5)
高血压	是	301	13(4.3)	1.777^a	0.182	1(0.3)	0.660^a	0.416
	否	325	22(6.8)			4(1.2)
糖尿病	是	105	10(9.5)	3.697^a	0.055	1(1.0)		1.000^c
	否	521	25(4.8)			4(0.8)
基础疾病数量	0	243	14(5.8)	9.229^b	0.026	3(1.2)	7.473^b	0.058
	1	296	11(3.7)			1(0.3)
	2	70	7(10.0)			0
	≥3	17	3(17.6)			1(5.9)
文化程度	小学及以下	167	6(3.6)	1.723^a	0.189	0	0.717^a	0.397
	初中及以上	459	29(6.3)			5(1.1)
家庭结构	独居	84	0	5.746^a	0.017	0		1.000^c
	非独居	542	35(6.5)			5(0.9)
经济来源	稳定收入	499	30(6.0)	2.547^a	0.280	4(0.8)		0.388^c
	儿女赡养	37	3(8.1)			1(2.7)
	无固定收入	90	2(2.2)			0
抽烟	是	78	3(3.8)	0.514^a	0.473	1(1.3)		0.487^c
	否	548	32(5.8)			4(0.7)
饮酒	是	96	8(8.3)	1.615^a	0.204	2(2.1)		0.170^c
	否	530	27(5.1)			3(0.6)
体育锻炼	是	480	29(6.0)	0.792^a	0.374	4(0.8)	0.001^a	0.999
	否	146	6(4.1)			1(0.7)
吃隔夜饭	是	370	27(7.3)	4.990^a	0.025	3(0.8)	0.001^a	0.999
	否	256	8(3.1)			2(0.8)
近3个月使用抗菌药物	是	393	28(7.1)	4.705^a	0.030	2(0.5)	0.352^a	0.553
	否	233	7(3.0)			3(1.3)
注：^a为χ²值，^b为H值，^c为采用Fisher精确检验。

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表 3 变量赋值方法

Table 3. Variable assignment methods

变量类型	项目	赋值方法
自变量	基础疾病数量	无=0，1种=1，2种=2，≥3种=3
	家庭结构	独居=0，非独居=1
	吃隔夜饭	否=0，是=1
	近3个月使用抗菌药物	否=0，是=1
因变量	SA定植	否=0，是=1

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表 4 金黄色葡萄球菌定植的多因素logistic回归分析

Table 4. Multivariate logistic regression analysis ofStaphylococcus aureus colonization

变量	B	SE	Wald χ²	P值	OR值	95% CI
基础疾病数量	0.330	0.214	2.368	0.124	1.391	0.914~2.118
家庭结构	0.926	0.365	6.447	0.011	2.523	1.235~5.155
吃隔夜饭	0.915	0.415	4.845	0.028	2.496	1.105~5.634
近3个月使用抗菌药物	0.873	0.435	4.017	0.045	2.394	1.019~5.620

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