目的比较医院骨科感染与社区感染金黄色葡萄球菌的耐药性,了解骨科患者感染金黄色葡萄球菌的药敏变化,分析其耐药性差异及原因,为临床合理选用抗菌药物提供参考。方法对贵州医科大学第三附属医院骨科2010年1月至2015年12月各类临床标本中分离出的金黄色葡萄球菌139株进行分析,样本区分医院感染和社区感染,对二者进行比较分析。病原菌鉴定采用VITEK-32微生物分析系统,药敏试验采用K-B纸片法,统计分析使用SPSS 19.0软件。结果骨科患者医院感染金黄色葡萄球菌检出率为19.76%,社区感染检出率为10.76%,医院感染患者检出率高于社区感染患者(χ2=8.10,P=0.004)。两种患者所检出的金黄色葡萄球菌对万古霉素(0.77%)、阿米卡星(1.96%)、利福平(4.19%)、替考拉宁(2.16%)、米诺环素(0.00%)和利奈唑胺(0.00%)等11种抗菌药物耐药率较低,可作为治疗的首选药。医院感染与社区感染的金黄色葡萄球菌对苯唑西林、头孢唑林、阿莫西林/克拉维酸、克林霉素、红霉素、阿奇霉素、庆大霉素、氧氟沙星、呋喃妥因、复方新诺明、罗红霉素、吗啉噁酮、奎奴普汀/达福普汀等17种抗菌药物的耐药率分别为70.97%、20.22%,50.00%、15.79%,50.00%、9.62%,53.13%、23.66%,82.76%、43.01%,83.33%、38.30%,22.22%、3.95%,19.05%、6.78%,21.74%、7.81%,41.38%、17.50%,66.67%、30.77%,14.29%、0.00%,14.29%、0.00%,医院感染金黄色葡萄球菌的耐药性高于社区感染的,差异具有统计学意义(P<0.05)。结论骨科医院感染患者金黄色葡萄球菌感染率和耐药率均高于社区感染患者,制订治疗方案时应区别医院感染与社区感染,合理使用抗菌药物,从而减少抗菌药物的滥用和细菌耐药性的产生。 Objective To compare the drug resistance of hospital-acquired orthopedic infections and community-acquired infections with Staphylococcus aureus, understand the changes of susceptibility to Staphylococcus aureus infection in orthopedic patients, analyze their differences in drug resistance and their causes, and provide a reference for the rational use of antibacterials in clinics. Methods 139 strains of Staphylococcus aureus isolated from various clinical samples from January 2010 to December 2015 in Department of Orthopedics, Third Affiliated Hospital of Guizhou Medical University were analyzed. The samples were divided into nosocomial infections and community-acquired infections, and the two were compared . Pathogen identification using VITEK-32 microbial analysis system, drug sensitivity test using K-B disc method, statistical analysis using SPSS 19.0 software. Results The detection rate of nosocomial Staphylococcus aureus in orthopedic patients was 19.76%. The detection rate of community infection was 10.76%. The detection rate of nosocomial infection was higher in patients with community infection than in those with community infection (χ2 = 8.10, P = 0.004). Staphylococcus aureus was detected in both patients against vancomycin (0.77%), amikacin (1.96%), rifampin (4.19%), teicoplanin (0.00%) and linezolid (0.00%) and other 11 kinds of antimicrobial resistance rate is low, can be used as the drug of choice for treatment. Staphylococcus aureus, nosocomial and cefazolin, cefazolin, amoxicillin / clavulanic acid, clindamycin, erythromycin, azithromycin, gentamicin, ofloxacin, nitrofurantoin, The antibacterial rates of 17 antibacterials such as cotrimoxazole, roxithromycin, morpholinozole and quinuptin / dalfopristin were 70.97%, 20.22%, 50.00%, 15.79% and 50.00% respectively, 9.62, 53.13, 23.66, 82.76, 43.01, 83.33, 38.30, 22.22, 3.95, 19.05, 6.78, 21.74, 7.81, 41.38, 17.50, 66.67, 30.77% , 14.29%, 0.00%, 14.29% and 0.00% respectively. The drug resistance of hospital-acquired Staphylococcus aureus was higher than that of community-acquired infection (P <0.05). Conclusion The infection rate and the drug resistance rate of Staphylococcus aureus in patients with orthopedic hospital infection are higher than those in community-acquired infection patients. The nosocomial infection and community infection should be distinguished when making the treatment plan, and the antibacterial drugs should be used reasonably so as to reduce the abuse of antibacterial drugs and bacterial resistance The production.