抗菌药物对肠球菌属细菌体外抗菌活性

目的了解抗菌药物对某院临床分离肠球菌属细菌的体外抗菌活性。方法对2013年6月—2014年7月该院临床各科室送检标本分离的188株肠球菌属细菌进行细菌鉴定及药物敏感试验。结果 188株肠球菌属细菌其中屎肠球菌119株、粪肠球菌60株、鸟肠球菌9株,主要分布在尿和血标本,分别占34.57%和19.15%。未检出对达托霉素及利奈唑胺耐药的肠球菌属细菌;屎肠球菌对万古霉素的耐药率为1.68%,对青霉素、氨苄西林、高浓度庆大霉素、红霉素、左氧氟沙星的耐药率均70%;除四环素外,粪肠球对其他抗菌药物的耐药率均低于屎肠球菌,粪肠球对青霉素、氨苄西林耐药率较低,分别为16.67%,13.33%。结论达托霉素对该院肠球菌属细菌具有良好的抗菌效果。     

390株肠球菌耐药性及Ⅰ类整合子的检测

目的调查390株肠球菌耐药性及Ⅰ类整合子的携带率,以利于临床治疗用药. 方法根据 NCCLS推荐的琼脂稀释法进行药敏试验,应用WHONET5软件进行统计分析;采用PCR方法进行Ⅰ类整合子的检测以及滤膜接合法进行质粒接合转移试验;联合药敏试验采用棋盘法. 结果粪肠球菌对氨苄西林、青霉素、氯霉素、左氧氟沙星MIC50和MIC90分别为4、16μg/ml;8、16μg/ml;16、64μg/ml;4、16μg/ml;屎肠球菌对上述4种抗菌药物的MIC50和MIC90分别为64、128μg/ml;64、128μg/ml;32、128μg/ml;32、128μg/ml;粪肠球菌和屎肠球菌对万古霉素MIC50和MIC90均分别为2μg/ml和4μg/ml;324株粪肠球菌和66株屎肠球菌Ⅰ类整合子的携带率分别为53.1%和51.5%;Ⅰ类整合子携带aadA2基因;40株粪肠球菌和20株屎肠球菌中的Ⅰ类整合子全部转移到受体菌中;对链霉素MIC≤2 000μg/ml的菌株,链霉素与氨苄西林的FIC指数≤0.5. 结论屎肠球菌对青霉素、氨苄西林、氯霉素、左氧氟沙星等抗菌药物的MIC50和MIC90显著高于粪肠球菌;万古霉素对粪肠球菌及屎肠球菌具有很好的抗菌作用;由质粒携带的整合子可通过质粒播散耐药性;携带Ⅰ类整合子及aadA2基因且非高耐链霉素的肠球菌,链霉素与氨苄西林具有协同抗菌作用.     

利奈唑胺等抗菌药物对肠球菌属体外抗菌活性评价 FREE

目的了解利奈唑胺等抗菌药物对某院临床分离的肠球菌属细菌的体外抗菌活性。方法采用美国德灵Microscan WalkAway 40全自动微生物分析仪对临床标本分离培养的肠球菌属细菌进行鉴定及药物敏感试验。结果117株肠球菌属细菌中未检出对利奈唑胺耐药的菌株;屎肠球菌和粪肠球菌对万古霉素的耐药率分别为4.41%和5.71%,对青霉素、氨苄西林、红霉素、高浓度庆大霉素、左氧氟沙星、环丙沙星等药物的耐药率达70%以上。结论利奈唑胺对肠球菌属细菌具有良好的抗菌效果,尤其对多重耐药株所致感染的控制将具有重要作用。     

211株肠球菌属细菌对18种抗生素的耐药性特征

目的了解肠球菌属对18种抗菌药物的耐药性. 方法采用纸片扩散法进行药敏试验. 结果 65株屎肠球菌对青霉素、氨苄西林和阿莫西林/克拉维酸耐药率分别为89.2%、85.1%和78.5%;146株粪肠球菌对青霉素、氨苄西林和阿莫西林/克拉维酸耐药率分别为7.2%、3.8%和3.9%,粪肠球菌对磷霉素的耐药率为2.8%;粪肠球菌对高浓度链霉素耐药率(60.1%)比高浓度庆大霉素耐药率(45.3%)高药15%,与粪肠球菌相反屎肠球菌对高浓度链霉素耐药率和高浓度庆大霉素的耐药率分别为50%和80.6%;211株菌对万古霉素、替考拉宁全部敏感,值得注意的是粪肠球菌和屎肠球菌对红霉素耐药率高达78.8%和95.3%;屎肠球菌对青霉素类、呋喃妥因、喹诺酮类、高浓度庆大霉素、红霉素和利福平的耐药性明显高于粪肠球菌,而对四环素类抗菌药物、高浓度链霉素和氯霉素的耐药性低于粪肠球菌. 结论粪肠球菌对抑制细菌细胞壁合成的青霉素、氨苄西林、阿莫西林/克拉维酸、万古霉素、替考拉宁和磷霉素,作用于核酸合成的药物利福平、喹诺酮类的诺氟沙星、环丙沙星、左氧氟沙星以及作用于微生物酶系统的呋喃妥因较敏感;屎肠球菌对作用于蛋白质合成的抗菌药物(除红霉素外)四环素、多西环素和米诺环素及氯霉素较敏感.     

676株肠球菌耐药性监测及万古霉素耐药基因研究

摘要:目的　探讨临床分离的肠球菌分布和耐药情况,以及耐万古霉素肠球菌（VRE）的基因型。方法　统计分析2013年1月-2014年3月,临床分离的肠球菌与药敏结果,VRE进一步用E-test药敏试验确认,PCR法检测VRE的耐药基因。结果　共分离出肠球菌属菌676株,以粪肠球菌354株（占52.4%）和屎肠球菌299株（占44.2%）为主;标本分布中以中段尿（占33.9%）、痰等呼吸道标本（占23.1%）和创面分泌物（占21.2%）为主;肠球菌属菌对万古霉素和替考拉宁仍极敏感,万古霉素耐药粪肠球菌和屎肠球菌检出率分别为0.3%、2.7%。粪肠球菌对氨苄西林、呋喃妥因、青霉素和磷霉素耐药率较低,分别为2.6%、6.0%、6.9%和8.2%,对左氧氟沙星和氯霉素耐药率＜30%;屎肠球菌耐药性明显高于粪肠球菌,对氨苄西林和青霉素的耐药率都超过95%,对左氧氟沙星、红霉素和利福平的耐药率均在90%左右,但对氯霉素的耐药率明显低于粪肠球菌,仅为5.1%。检出9株VRE,其基因型均为VanA。结论 已发现9株VRE,应该加强医院感染控制,防止VRE的暴发流行。     

利奈唑胺等抗菌药物对肠球菌属体外抗菌活性评价

目的了解利奈唑胺等抗菌药物对某院临床分离的肠球菌属细菌的体外抗菌活性。方法采用美国德灵Microscan WalkAway-40全自动微生物分析仪对临床标本分离培养的肠球菌属细菌进行鉴定及药物敏感试验。结果 117株肠球菌属细菌中未检出对利奈唑胺耐药的菌株;屎肠球菌和粪肠球菌对万古霉素的耐药率分别为4.41%和5.71%,对青霉素、氨苄西林、红霉素、高浓度庆大霉素、左氧氟沙星、环丙沙星等药物的耐药率达70%以上。结论利奈唑胺对肠球菌属细菌具有良好的抗菌效果,尤其对多重耐药株所致感染的控制将具有重要作用。     

166株肠球菌属的临床分布及耐药分析

目的了解肠球菌属的分布及常用抗菌药物的耐药性情况,为临床合理用药提供依据。方法细菌鉴定应用API 20Strep板条和ATB NEW系统,药敏试验采用K-B法。结果临床分离到的166株肠球菌属中,粪肠球菌96株(57.83%),屎肠球菌68株(40.96%);主要分离自尿液53株(31.93%)、脓液42株(25.30%)和伤口分泌物29株(17.47%);屎肠球菌的耐药率普遍较粪肠球菌高,特别是对红霉素的耐药率最高,为95.59%,对环丙沙星、左氧氟沙星、青霉素、氨苄西林、利福平及高浓度庆大霉素的耐药率均80.00%;粪肠球菌对红霉素和四环素耐药率均80.00%,未发现喹奴普汀/达福普汀敏感粪肠球菌;虽然肠球菌属的药敏要求对其进行β-内酰胺酶的检测以推导对青霉素、氨苄西林、阿莫西林耐药性,但未发现有β-内酰胺酶阳性菌株,也未发现对万古霉素耐药的菌株。结论肠球菌属是医院感染的重要病原菌之一,临床治疗肠球菌属引起的感染时应根据药敏结果合理用药。     

2007-2009年屎肠球菌及粪肠球菌的耐药性分析

目的了解医院近年来屎肠球菌和粪肠球菌的耐药性变迁,为临床合理使用抗菌药物及控制医院感染提供依据。方法用ATB细菌鉴定仪鉴定菌种,对2007-2009年临床分离的156株屎肠球菌和136株粪肠球菌,用纸片扩散法检测氨苄西林等10种抗菌药物的敏感性,并对药敏试验结果进行分析。结果收集的156株屎肠球菌和136株粪肠球菌中,屎肠球菌对红霉素、氨苄西林、青霉素G、左氧氟沙星、呋喃妥因、高浓度庆大霉素、四环素、万古霉素、替考拉宁、利奈唑胺的耐药率分别为98.1%、96.8%、96.8%、95.5%、93.6%、86.5%、66.7%、3.2%、1.9%、0。粪肠球菌对红霉素、四环素、左氧氟沙星、高浓度庆大霉素、呋喃妥因、氨苄西林、青霉素G、万古霉素、替考拉宁、利奈唑胺的耐药率分别为80.9%、72.8%、61.8%、43.3%、36.8%、17.6%、17.6%、0、0、0。结论医院临床分离的粪肠球菌对氨苄西林和青霉素G的耐药性较低,3年比较,屎肠球菌耐药性均明显高于粪肠球菌。     

243株肠球菌属临床分离株分布及抗菌药物敏感性分析

目的统计与分析海军总医院2008-2010年分离的肠球菌属对抗菌药物敏感试验结果,了解肠球菌属在临床各病区的分布情况以及抗菌药物敏感性,从而为肠球菌属的合理用药提供科学依据。方法按常规方法进行肠球菌属的分离培养与鉴定;用VITEK-32细菌鉴定仪进行菌株的鉴定;用K-B法进行抗菌药物药物敏感性试验,Bio-Mic药敏分析仪进行药物敏感性测定;用Whonet5.4软件进行药敏结果的统计和分析。结果 2008-2010年海军总医院共分离出243株肠球菌属,其中屎肠球菌、粪肠球菌、铅黄肠球菌、鹑鸡肠球菌、鸟肠球菌、耐久肠球菌、海氏肠球菌分别占56.0%、28.8%、7.0%、4.1%、2.1%、1.6%、0.4%,分离率占前3位的标本类型依次为尿液、分泌物和血液,共206株,占84.8%;尿路感染中以粪肠球菌为主,其次是屎肠球菌和铅黄肠球菌,屎肠球菌和铅黄肠球菌耐药率更高;检出率占前3位的科室分别为ICU、泌尿外科和呼吸内科;屎肠球菌耐药性高于粪肠球菌,对屎肠球菌耐药率最高的前3位抗菌药物分别是氨苄西林、青霉素和红霉素,耐药率分别为100.0%、97.1%和93.4%;对粪肠球菌耐药率最高的前3位抗菌药物分别是红霉素、四环素和左氧氟沙星,耐药率分别是80.0%、42.9%和38.6%。结论海军总医院分离的肠球菌属以屎肠球菌为主,肠球菌属间耐药性存在较大差异,治疗时应根据耐药特点及耐药性差异选择相应的药物,目前万古霉素仍然是治疗肠球菌属感染的有效药物。     

中段尿培养215株肠球菌耐药性分析

目的了解尿路感染患者的中段尿分离出肠球菌的种类、分布及耐药情况,为肠球菌性尿路感染的治疗提供参考。方法对病人中段尿标本中培养分离的215株肠球菌的培养、菌种鉴定及药敏试验结果进行分析。结果215株肠球菌中,粪肠球菌108株(50.2%),屎肠球菌103株(47.9%),鹑鸡肠球菌4株(1.9%),感染以粪肠球菌和屎肠球菌为主(98.1%)。粪肠球菌、屎肠球菌对奎奴普丁/达福普汀和四环素的耐药率分别为97.7%、87.0%和9.7%、44.7%,粪肠球菌的耐药率较高。其余抗生素(除万古霉素外)如氨苄西林、环丙沙星、呋喃妥因、高浓度链霉素等,屎肠球菌均高于粪肠球菌;粪肠球菌对左氧氟沙星及环丙沙星的耐药率均为28.7%,而屎肠球菌则均为97.1%,屎肠球菌多重耐药现象更严重。结论肠球菌已经成为尿路感染的重要病原菌,两种菌株对临床常用抗菌药物均严重耐药;不同种属肠球菌对多种抗菌药物耐药率有较大差异。应加强对重点人群的监测和管理,根据菌种间的耐药差异和药敏结果,指导临床合理选用抗菌药物,以更有效控制感染。     

emeA基因的存在及表达与肠球菌属耐药的相关性研究

目的 研究肠球菌属临床株emeA基因的存在和表达与肠球菌属耐药的相关性.方法 用聚合酶链反应(PCR)法检测基因emeA在肠球菌属临床株中的分布,用RT-PCR法测定emeA基因阳性菌株中,emeA mRNA的表达水平;用琼脂稀释法检测5种抗菌药物,对肠球菌属的最低抑菌浓度(MIC).结果 112株肠球菌属中,emeA基因的阳性率为50.9％;左氧氟沙星、氨苄西林、庆大霉素和红霉素耐药的肠球菌属中emeA基因的阳性率分别为76.0％、58.3％、85.7％、55.7％;敏感株中分别为30.6％、50.0％、23.8％、33.3％;肠球菌属多药耐药组和单一耐药组emeA基因,与内参灰度比值的平均值分别为1.485和1.099,差异有统计学意义(P＜0.01).结论 emeA基因的存在情况与肠球菌属对左氧氟沙星、庆大霉素和红霉素耐药有显著相关性,对氨苄西林耐药无明显相关性;多药耐药组的emeA基因mRNA表达水平显著高于单一耐药组.     

Emergence of vancomycin-resistant enterococci

Vancomycin and ampicillin resistance in clinical Enterococcus faecium strains has developed in the past decade. Failure to adhere to strict infection control to prevent the spread of these pathogens has been well established. New data implicate the use of specific classes of antimicrobial agents in the spread of vancomycin-resistant enterococci (VRE). Extended-spectrum cephalosporins and drugs with potent activity against anaerobic bacteria may promote infection and colonization with VRE and may exert different effects on the initial establishment and persistence of high-density colonization. Control of VRE will require better understanding of the mechanisms by which different classes of drugs promote gastrointestinal colonization.     

In vitro susceptibility studies and detection of vancomycin resistance genes in clinical isolates of enterococci in Nagasaki,Japan.

Glycopeptide resistance in enterococci is now a cause of clinical concern in the United States and Europe. However, details of vancomycin resistance in enterococci in Japan have been unknown. We measured minimum inhibitory concentrations (MICs) of various antimicrobial agents for a total of 218 clinical strains of enterococci isolated in our hospital in 1995-6 in addition to 15 strains with known genotypic markers of resistance. We also screened vancomycin resistance genes using a single step multiplex-PCR. In clinical isolates, only two strains of Enterococcus gallinarum were of intermediate resistance to vancomycin (MIC, 8 micrograms/ml), while the others were all susceptible. Glycopeptides (vancomycin and teicoplanin) and streptogramins (RP 58500 and RPR 106972) showed potent antimicrobial effects for the isolates. In addition, ampicillin was also potent for Enterococcus faecalis, while ampicillin, minocycline and gentamicin were potent for Enterococcus avium. No vanA or vanB genes were detected, while vanC1 and vanC23 genes were detected from two and four strains, respectively. Our results suggest that incidence of VRE in Japan may be estimated as still very low at this time.     

A multicentre study:Staphylococcus andEnterococcus susceptibility to antibiotics

A multicentre study to evaluate the susceptibility of Gram-positive cocci isolated from clinical samples, was performed by six centres working in different areas of Italy. We examined 4,544 strainsof Staphylococcus aureus, 4,381 strains of coagulase-negative staphylococci and 2,478 strains of enterococci. The following antibiotics were tested: penicillin G, ampicillin, amoxicillin, piperacillin, imipenem, oxacillin, ofloxacin, pefloxacin, ciprofloxacin, gentamicin, tobramycin, amikacin, netilmicin, rifampicin, clindamycin, tetracycline, cotrimoxazole, erythromycin, chloramphenicol, vancomycin and teicoplanin. Oxacillin-susceptible staphylococci confirmed their susceptibility to many other antimicrobial agents while oxacillin-resistant strains confirmed their multiple and frequent resistance to antibiotics. Resistance to oxacillin, cotrimoxazole and chloramphenicol was more frequent in coagulase-negative staphylococci than inStaphylococcus aureus. Aminoglycosides, rifampicin and quinolones were more active against coagulase-negative staphylococci than againstStaphylococcus aureus. Enterococci were susceptible to penicillins and imipenem, and moderately susceptible to cipro-floxacin. Susceptibility of 70–79% was observed with high levels of aminoglycosides. Excellent results against staphylococci and enterococci were observed with vancomycin and teicoplanin.     

儿童呼吸道卡他莫拉菌分离株产β-内酰胺酶情况和耐药性以及菌株BRO酶基因特征

目的研究儿童呼吸道卡他莫拉菌分离株产β-内酰胺酶情况和耐药性以及菌株BRO酶基因特征。方法选择2016年2月-2019年1月因呼吸道感染就诊且从痰液标本中分离得到卡他莫拉菌的患儿,测定抗生素敏感性、产β-内酰胺酶情况、BRO酶基因表达情况。结果产酶菌株对氨苄西林、阿莫西林、头孢克洛、头孢呋辛、头孢吡肟、左氧氟沙星、克拉霉素产生耐药的发生率高于非产酶菌株,BRO-1基因阳性菌株对氨苄西林、阿莫西林、头孢克洛、头孢呋辛、头孢吡肟、左氧氟沙星、克拉霉素产生耐药的发生率高于BRO-2基因阳性菌株;产酶菌株和非产酶菌株、BRO-1基因阳性和BRO-2基因阳性菌株均对亚胺培南敏感,未发生耐药。结论儿童呼吸道卡他莫拉菌产β-内酰胺酶比例高,且BRO-1基因阳性菌株的耐药性强于BRO-2基因阳性菌株。     

临床分离肠球菌属的菌群分布及耐药性变迁

目的了解医院临床分离肠球菌属的菌群分布及耐药性变化,为临床合理用药提供依据。方法各种临床标本经分离培养,用ATB Expression细菌鉴定仪鉴定,用ATB ENTEROC药敏试条进行药敏试验,并作统计分析。结果50148份临床标本中检出肠球菌属1 354株,分离率为2.7%,菌种以粪肠球菌为主,其次为屎肠球菌;肠球菌属在各种临床标本中分布仍以尿液为主,痰液标本中肠球菌属的比例逐年增加;肠球菌属对红霉素、利福平、环丙沙星、左氧氟沙星具有较高的耐药性,而万古霉素和替考拉宁仍然保持很好的敏感性。结论在细菌种类和耐药性方面引起感染的肠球菌属均发生了较大变化,不同种类的细菌其耐药性差异较大,因此,临床上在治疗肠球菌属感染时,应根据药敏试验结果选择敏感的抗菌药物,以提高疗效,减少医院感染。     

左氧氟沙星、环丙沙星单用和联合其他抗菌药物对铜绿假单胞菌防突变浓度的研究

目的了解左氧氟沙星、环丙沙星单用及其与头孢他啶、美罗培南、阿米卡星联合使用，对铜绿假单胞菌防突变浓度（MPC）的变化。方法采用琼脂稀释法测定上述抗菌药物单用及联合使用对8株左氧氟沙星、环丙沙星敏感铜绿假单胞菌的MPC，并计算耐药频率。结果左氧氟沙星、环丙沙星单用对上述8株铜绿假单胞菌MPC／MIC分别为8～32、8～16；两药分别与头孢他啶、美罗培南和阿米卡星联合使用，MPC／MIC则降为2～8、2～4、1～2、1～2、4～8和1～8，联合用药较单独用药MPC／MIC下降2～16倍，且其耐药频率也大幅下降。结论联合用药能使耐药突变选择窗变窄，使MPC／MIC降低，减少耐药菌产生。     

Antimicrobial susceptibility of polymerase chain reaction ribotypes of Clostridium difficile commonly isolated from symptomatic hospital patients in the UK

Two hundred and seventy-one clinical isolates of Clostridium difficile, including the six most common polymerase chain reaction (PCR) ribotypes isolated from symptomatic patients in UK hospitals, were tested against nine antibiotics (imipenem, erythromycin, levofloxacin, piperacillin/tazobactam, ciprofloxacin, co-amoxiclav, cefotaxime, amoxicillin and clindamycin). All 271 strains were susceptible to co-amoxiclav, piperacillin/tazobactam and amoxicillin, and resistant to cefotaxime and ciprofloxacin. Variable degrees of resistance were found to imipenem, erythromycin, levofloxacin and clindamycin. Significantly greater resistance to erythromycin, levofloxacin and imipenem was found in virtually all members of the two most common PCR ribotypes, 001 and 106. Resistance to these agents may have played a part in their selection as the most common strains of C. difficile found in UK hospitals.