医院肠球菌属分布特征及耐药性变迁

目的了解肠球菌属的分布特征及耐药性的变迁,为临床治疗提供参考。方法回顾性总结2002-2005年医院各类临床标本分离出的99株肠球菌属,对其分布特点、检出率及药敏结果进行统计、分析。结果临床标本分离病原菌中革兰阳性球菌占34.2%,肠球菌属占3.0%,且有逐年上升趋势;肠球菌属中以粪肠球菌比例最高,屎肠球菌次之;肠球菌属在标本中检出率最高,其次为尿液和血液;肠球菌属总体耐药水平较高,仅对哌拉西林/他唑巴坦、呋喃妥因、利福平、万古霉素较为敏感;屎肠球菌对青霉素、哌拉西林、哌拉西林/他唑巴坦、环丙沙星、万古霉素耐药率显著高于粪肠球菌,而对四环素耐药率却显著低于粪肠球菌;2005年与2002年相比,粪肠球菌对青霉素、庆大霉素、高浓度庆大霉素、四环素、环丙沙星、头孢他啶、万古霉素耐药率显著增高(P<0.05或P<0.01);而屎肠球菌对青霉素、红霉素、环丙沙星、氯霉素、四环素耐药率显著降低(P<0.05或P<0.01),万古霉素耐药率已达32.0%。结论肠球菌属感染以粪肠球菌、屎肠球菌为主;肠球菌属总体耐药率较高,屎肠球菌耐药性高于粪肠球菌;临床治疗应根据病原菌药物敏感试验结果合理应用抗菌药物,同时应采取必要的预防措施。

Distribution and Change in Drug Resistance of Enterococcus in Hospital

OBJECTIVE To investigate the characteristic of distribution and the change in drug resistance of Enterococcus in hospital to provide reference for clinical therapy.METHODS The distribution and drug resistance of 99 strains of enterococci isolated from various clinical specimens of the infections from 2002 to 2005 were retrospectively analyzed.RESULTS The Gram-positive cocci isolated from clinical specimens in our hospital accounted for 34.2%,enterococci accounted for 3.0%,and they showed an increasing tendency in recent years.Among 99 strains of enterococci,the most organism was Enterococcus faecalis(62.6%),the second was E.faecium(25.2%).The main localities from where the enterococci isolated were respiratory tract(36.3%),then blood origin(20.2%) and urinary tract(18.8%).Enterococci strains were resistant to multiple antibiotics,but sensitive to piperacillin/tazobactam,nitrofurantoin,rifampicin and vancomycin.The resistance rates of E.faecium to penicillin,piperacillin,piperacillin/tazobactam,ciprofloxacin and vancomycin were significantly higher than that of E.faecalis, but contrary to tetracycline.Compared with the drug resistance rates of E.faecalis to penicillin,gentamicin,high level gentamicin,tetracycline,ciprofloxacin,ceftazidime and vancomycin in 2002,they were significantly increased in 2005(P<0.05 or P<0.01), and the drug resistance rates of E.faecium to penicillin,erythromycin,ciprofloxacin,chloramphenicol and tetracycline significantly decreased in 2005(P<0.05 or P<0.01),but to vancomycin was 32.0%.CONCLUSIONS The most common enterococci causing hospital infection are E.faecalis and E.faecium.The drug resistance rate of E.faecium is higher than that of E.faecalis.The antibacterial agents should be reasonably applied according to antimicrobial susceptibility test during clinical therapy,further more,the necessary steps should be carried out else to prevent the enterococcal infection.