某医院临床分离肠球菌药敏分析

目的了解肠球菌的体外抗菌药物敏感性，为临床合理用药提供参考。方法用MicroScan WalkAway 96SI全自动微生物鉴定和药敏系统对从四川大学华西医院临床分离的409株肠球菌进行鉴定和药敏试验，对菌株标本来源、科室分布及药敏结果进行统计分析。结果2006—2007年共分离出409株肠球菌，常见的是粪肠球菌（47．2％）、屎肠球菌（41．8％）和酪黄肠球菌（8．1％）；临床标本前5位依次是尿液（30．1％）、分泌物（20．5％）、腹水（15．4％）、血液（9．8％）和胆汁（7．1％）；临床科室分离菌株数量前5位是普外科（16．6％）、ICU（11．7％）、骨外科（11．5％）、内分泌科（9．0％）和感染科（8．8％）。抗菌药物药敏试验结果显示，粪肠球菌对万古霉素耐药率最低，对青霉素、氨苄西林、呋喃妥因的耐药率低于12％，对诺氟沙星、环丙沙星和利福平的耐药率为40％～48％，对红霉素和四环素的耐药率为66％～75％，高耐链霉素和高耐庆大霉素分离率分别是45．1％和60．1％。除四环素外，酪黄肠球菌比粪肠球菌更耐药，而屎肠球菌是最耐药的。结论临床分离的以粪肠球菌、屎肠球菌和酪黄肠球菌常见，主要来源于尿液、分泌物和腹水。除四环素外，耐药性从低到高依次是粪肠球菌、酪黄肠球菌和屎肠球菌，万古霉素耐药率最低。

Invitro Susceptibility to Antimicrobial Agents of Clinical Isolates of Enterococci

Objective To investigate invitro antimicrobial susceptibility of Enterococci and guide the rational clinical use of drug. Methods Statistical analysis was performed on the specimen distribution, clinical distribution and antimicrobial susceptibility of the 409 strains of Enterococci, which were isolated from clinical specimens of West China Hospital, Sichuan University. Automatic bacterial identification and antimicrobial susceptibility tests were carried out by using the MicroScan Walk- Away 96SI system. Results From 2006 to 2007, 409 strains of Enterococci were isolated, and the most common isolates were Enterococus faecalis（47.2% ）, Enterococus faecium（41.8% ） and Enterococus casseliflavus（8. 1% ）. The top five specimens were urine （30. 1% ）, secretion （20. 5% ）, ascites （ 15.4% ）, blood （9. 8% ） and bile （7. 1% ）. The most frequently isolated strains were separated from the departments of general surgery （ 16. 6% ）, ICU （ 11.7% ）, orthopedics （ 11.5% ）, endocrinology （ 9.0% ） and infectious disease （8.8%）. Enterococus faecalis showed the lowest resistant rate to vancomycin, the resistant rate to peneciUin, ampicillin and nitrofurantoin were lower than 12% ; which of norfloxacin, ciprofloxacin and rifampin were from 40% to 48% ; and that to erythromycin and tetracycline were from 66% to 75%. The isolate rates of Enterococus faecalis resistant to high-level streptomycin and high-level gentamicin were 45. 1% and 60. 1%, respectively. Except for tetracycline, Enterococus casseliflavus was more resistant than Enterococus faecalis, and the most resistant specie was Enterococus faecium. Conclusions The most common isolates are Enterococus faecalis, Enterococus faecium and Enterococus casseliflavus. The three are most frequently isolated form specimens of urine, secretion and ascites. Except for tetracycline, Enterococus faecalis, Enterococus casseliflavus and Enterococus faecium are the strains with resistant rate from low to high. Vancomycin is with the lowest res