高水平氨基糖苷耐药肠球菌的监测

目的了解高水平氨基糖苷耐药(HLAR)肠球菌的分离率,探讨青霉素类或糖肽类与氨基糖苷类药物合用对院内感染肠球菌的协同杀菌作用,为临床治疗肠球菌感染提供参考与指导.方法采用VITEK-AMS仪器对分离自临床标本的101株肠球菌进行氨苄西林、青霉素、万古霉素耐药性和高水平庆大霉素耐药(HLGR)及高水平链霉素耐药(HLSR)测定.结果101株肠球菌中,粪肠球菌、屎肠球菌、鸟肠球菌、母鸡肠球菌和耐久肠球菌菌株分别为71、13、8、7和2株.药敏测试结果显示肠球菌对氨苄西林、青霉素、万古霉素耐药分别为21、34和0株;HLGR和HLSR分别为79株和46株. 结论院内感染肠球菌对抗菌药物存在严重耐药性,合理的抗菌药物治疗对高水平氨基糖苷耐药肠球菌感染患者的康复尤为重要.     

氨基苷类高水平耐药肠球菌的耐药性及修饰酶基因分布

目的明确临床分离的氨基苷类高水平耐药肠球菌（HLAR）耐药性及修饰酶基因类型。方法用琼脂筛选法筛选出HLAR、庆大霉素高水平耐药肠球菌（HLGR）及链霉素高水平耐药肠球菌（HLSR）；采用K—B法测定粪肠球菌及屎肠球菌对12种抗菌药物的耐药性；PCR及序列分析法检测7种氨基苷类修饰酶基因。结果肠球菌中HLAR为73．6％。利奈唑胺、万古霉素和替考拉宁对HLAR的抗菌作用最好，未检出耐药株。屎肠球菌中B内酰胺类抗生素耐药株以及喹诺酮类药物耐药株明显高于粪肠球菌。所有的屎肠球菌氨基苷类高耐株对氨苄西林、氨苄西林-舒巴坦及环丙沙星均耐药。aac（6′）-Ie-aph（2″）-Ia基因是HLGR的主要耐药基因，占HLGR的92．6％；3株HLGR存在与aph（2″）-Id高同源性的基因。而6′-ant、3″-ant及str基因在HLSR中的检出率低。结论HLAR已成为医院感染的重要耐药菌。HLGR主要通过aac（6′）-Ie-aph（2″）-Ia基因编码的修饰酶造成对庆大霉素高度耐药。     

166株分离自前列腺液中肠球菌的耐药性分析

目的监测2000至2004年分离的肠球菌的耐药情况,为治疗其感染提供参考资料。方法采集来我院就诊的1 186例患者的前列腺液标本进行细菌培养,采用生物梅里埃API条进行细菌鉴定,标准纸片扩散法进行耐药性分析。结果1 186例患者中共分离到肠球菌166株,其中粪肠球菌68株,屎肠球菌92株,其他肠球菌6株。耐药性检测结果显示,粪肠球菌对青霉素、氨苄西林、环丙沙星及左氧氟沙星的耐药率分别为48.53%、41.18%、50.00%、47.69%。而屎肠球菌的耐药率则分别为94.38%、90.32%、93.55%、91.95%。氨基糖苷类高水平耐药筛选屎肠球菌耐药率也高于粪肠球菌。肠球菌对万古霉素的耐药性最低,粪肠球菌为0%,屎肠球菌为3.26%。结论肠球菌对临床常用的头孢类抗生素呈天然耐药,万古霉素的敏感性最高,但已有万古霉素耐药菌株出现,耐万古霉素肠球菌(VRE)的出现需要引起高度重视,要防止万古霉素的过度使用,预防VRE的产生。     

166株分离自前列腺液中肠球菌的耐药性分析

目的监测2000至2004年分离的肠球菌的耐药情况,为治疗其感染提供参考资料。方法采集来我院就诊的1 186例患者的前列腺液标本进行细菌培养,采用生物梅里埃API条进行细菌鉴定,标准纸片扩散法进行耐药性分析。结果1 186例患者中共分离到肠球菌166株,其中粪肠球菌68株,屎肠球菌92株,其他肠球菌6株。耐药性检测结果显示,粪肠球菌对青霉素、氨苄西林、环丙沙星及左氧氟沙星的耐药率分别为48.53%、41.18%、50.00%、47.69%。而屎肠球菌的耐药率则分别为94.38%、90.32%、93.55%、91.95%。氨基糖苷类高水平耐药筛选屎肠球菌耐药率也高于粪肠球菌。肠球菌对万古霉素的耐药性最低,粪肠球菌为0%,屎肠球菌为3.26%。结论肠球菌对临床常用的头孢类抗生素呈天然耐药,万古霉素的敏感性最高,但已有万古霉素耐药菌株出现,耐万古霉素肠球菌（VRE）的出现需要引起高度重视,要防止万古霉素的过度使用,预防VRE的产生。     

临床分离肠球菌对12种抗菌药物耐药性监测

目的 :监测重庆地区 1997— 1998年临床分离肠球菌的耐药性。方法 :采用试管双倍稀释法测定 12种抗菌药物的最低抑菌浓度 (MIC)。结果 :共监测肠球菌 2 4 4株 ,其中 14 4株粪肠球菌、75株屎肠球菌、18株鸟肠球菌、7株鸡肠球菌。结果表明肠球菌对替考拉宁和万古霉素的耐药性最低 ,耐药率分别为 2 .13%和 8.84 % ;肠球菌对青霉素、哌拉西林、氨苄西林、苯唑西林、环丙沙星的耐药性也较低 ,耐药率分别为 9.4 2 %、13.5 2 %、16 .5 5 %、2 5 .85 %、2 6 .14 % ;肠球菌对其他药物的耐药率均大于 5 0 % ,;屎肠球菌对抗菌药物的耐药性明显高于粪肠球菌。结论 :万古霉素及替考拉宁对肠球菌的抗菌活性最高 ;青霉素、氨苄西林、哌拉西林对肠球菌仍具有较稳定的抗菌活性 ,屎肠球菌对抗菌药物的耐药性较粪肠球菌为高 ,临床上已出现了对糖肽类抗生素万古霉素及替考拉宁耐药的肠球菌 ,值得重视。     

2009—2013年肠球菌属临床感染及耐药性分析

目的了解肠球菌属临床分布及耐药性特征,为临床合理使用抗菌药物提供依据。方法回顾性分析855株临床分离的肠球菌,采用VITEK2 Compact全自动微生物分析仪做细菌鉴定和药敏试验,K-B纸片法筛检高水平庆大霉素耐药株,数据统计分析用WHONET5.5软件。结果共检出465株屎肠球菌和347株粪肠球菌,主要分离自尿液、引流液和伤口分泌物。屎肠球菌总体耐药率较高,其对氨苄西林、环丙沙星、青霉素和左氧氟沙星耐药率≥71.4%,明显高于粪肠球菌对这4种抗菌药物的耐药率(≤37.2%);粪肠球菌对四环素、奎奴普丁-达福普汀的耐药率(分别为76.4%和72.6%)明显高于屎肠球菌对这两种抗菌药物的耐药率(分别为59.4%和5.6%);两种细菌对红霉素均显示较高的耐药率(≥76.9%),对万古霉素和替考拉宁耐药率较低(均≤2.2%)。812株屎肠球菌和粪肠球菌中共筛检出高水平庆大霉素耐药株537株,占66.1%(537/812)。结论肠球菌属感染以屎肠球菌、粪肠球菌为主;屎肠球菌对大多数抗菌药物耐药率高于粪肠球菌;已检出多株万古霉素耐药肠球菌;大部分肠球菌为高水平庆大霉素耐药株;临床治疗应根据病原菌药物敏感试验结果选择适当的治疗药物。     

粪肠球菌和屎肠球菌的临床分布及耐药监测研究

目的 研究临床感染患者中粪肠球菌和屎肠球菌的临床分布、对抗菌药物的敏感性以及耐药情况。方法北京积水潭医院2014年1月至2015年12月临床送检的感染标本,分离粪肠球菌和屎肠球菌进行鉴定和药敏分析。结果 分离出粪肠球菌184株,屎肠球菌109株。粪肠球菌药物敏感性从高到低依次为万古霉素、替考拉宁、氨苄西林、呋喃妥因、利奈唑胺、高浓度庆大霉素。屎肠球菌药物敏感性从高到低依次为替考拉宁、利奈唑胺、万古霉素、四环素、高浓度庆大霉素。检测出耐高浓度庆大霉素(HLGR)粪肠球菌75株,分离率为40.76%,HLGR屎肠球菌48株,分离率为44.04%。检测出2株耐万古霉素的粪肠球菌,分离率为1.09%,9株耐万古霉素霉素的屎肠球菌,分离率为8.26%。结论 肠球菌属的总体耐药率较高,且综合评价屎肠球菌的耐药性高于粪肠球菌,但肠球菌属对于万古霉素、利奈唑胺、替考拉宁等仍然保持较高的敏感性,临床上应选用合适的方法对肠球菌属进行耐药性检测,根据药敏结果选择适当的抗菌药物治疗。     

泌尿系统分离肠球菌耐药性分析

目的了解该院患者泌尿系统分离的肠球菌耐药现状,为临床合理用药提供依据。方法对该院2011年1月至2012年12月期间所有泌尿系统分离的肠球菌药敏结果进行回顾性分析。结果泌尿系统共分离肠球菌109株,屎肠球菌分离率（53.2%）,略高于粪肠球菌（44.0%）。肠球菌对万古霉素、替考拉宁的敏感性最高,均高于90%。发现耐万古霉素的屎肠球菌（VRE）4株,其中3株同时耐高浓度的氨基糖苷类抗菌药物（HLAR）;对红霉素、克林霉素、复方磺胺、阿米卡星、庆大霉素、妥布霉素、苯唑西林、头孢西丁耐药率最高,均高于90%。屎肠球菌对青霉素类、氨苄西林、呋喃妥因、环丙沙星耐药率均高于粪肠球菌;对四环素、奎努普丁/达福普汀耐药率低于粪肠球菌。结论肠球菌是引起泌尿系统感染的重要病原菌之一,且呈多重耐药性,屎肠球菌和粪肠球菌耐药水平差异较大,临床应根据不同种类的肠球菌及药敏结果合理选择抗菌药物。     

耐万古霉素肠球菌的流行病学及临床检测方法研究进展

随着抗菌药物的广泛应用,肠球菌耐药株日益增多,氨基糖苷类高水平耐药肠球菌(high-level aminoglycoside-resistant enterococcus,HLAR)和耐万古霉素肠球菌(Vancomycin resistant enterococcus,VRE)分离率更是快速增长[1-3].相关文献报道,部分美国医院肠球菌所致重症监护病房患者感染中28%由VRE所引起[4].     

某医院2009~2013年粪肠球菌和屎肠球菌的耐药性监测

目的 了解2009~2013年该院临床分离粪肠球菌和屎肠球菌对各类抗菌药物的耐药性。方法 临床分离菌采用最低抑菌浓度法进行细菌的药敏试验,结果按临床实验室标准化协会2013年版的标准进行判断。结果 共分离得到非重复粪肠球菌819株,屎肠球菌726株,这两种菌株对利奈唑胺和万古霉素仍很敏感,耐药率均低于1.5%。粪肠球菌和屎肠球菌对万古霉素的耐药率分别为0.1%和1.5%。粪肠球菌对青霉素、氨苄西林和呋喃妥因的耐药率较低,分别为4.3%、1.6%和1.6%;屎肠球菌对青霉素和氨苄西林的耐药率都在87.0%以上,明显高于粪肠球菌。结论 该院的肠球菌感染中以粪肠球菌为主,屎肠球菌感染次之,二者的耐药性差异明显,持续监测其耐药情况有助于指导临床合理用药。     

Susceptibility patterns of enterococci causing infections

Enterococci are among the common organisms associated with hospital-acquired infections. We examined in vitro activities of different antibiotics to 103 enterococcal isolates. Minimal inhibitory concentrations (MICs) of penicillin G, ampicillin, gentamicin, ciprofloxacin, ofloxacin, levofloxacin, grepafloxacin, trovafloxacin and gemifloxacin were determined by broth microdilution testing method. Among the isolates 71 (69%) were identified as E. faecalis and 32 (31%) as E. faecium. While over 75% of E. faecium isolates were resistant to penicillin and ampicillin, approximately 25% of E. faecalis isolates were resistant to penicillin and ampicillin. None of the E. faecalis and E. faecium isolates were resistant to vancomycin. While 17 (52%) of E. faecium isolates exhibited high-level gentamicin resistance (HLGR), high level streptomycin resistance (HLSR) was detected in 24 (74%) of the isolates. In contrast, HLGR and HLSR rates for E. faecalis were 14 (20%) and 22 (31%), respectively. Both HLGR and HLSR were detected with higher frequency in ampicillin resistant isolates. Among fluoroquinolones, gemifloxacin and trovafloxacin were the most potent antibiotics tested. There was no increase in MIC90 values of the fluoroquinolones in ampicillin resistant isolates in comparison with ampicillin susceptible isolates. Our data suggest newer fluoroquinolones would be good alternative agents to use especially for combination drug therapy where enterococci with ampicillin resistance and HLAR are prevalent.     

Prevalence of resistance to ampicillin,gentamicin and vancomycin in Enterococcus faecalis and Enterococcus faecium isolates from clinical specimens and use of antimicrobials in five Nordic hospitals

We determined the species distribution and prevalence of ampicillin resistance, high-level gentamicin resistance (HLGR) and vancomycin resistance among clinical enterococcal isolates from five Nordic laboratories (Bergen, Troms?, Uppsala, Aarhus and Reykjavik). Isolates represented three different groups: (i) all blood culture isolates from 1999; (ii) consecutive in-patient isolates (maximum 40); and (iii) consecutive outpatient isolates (maximum 40) collected during March to May 2000. Antimicrobial use data were collected at the national and hospital level. A high proportion (31.4%) of Enterococcus faecium was detected among blood culture isolates, in contrast to only 4.2% among isolates from outpatients. Ampicillin resistance was not found in Enterococcus faecalis, in contrast to 48.8% in E. faecium isolates. HLGR rates varied considerably between laboratories (1.1-27.6%). Acquired vancomycin resistance was not detected. There were no significant differences in the prevalences of HLGR between in-patient and outpatient isolates at individual hospitals. A cluster of clonally related ampicillin-resistant and HLGR E. faecium isolates was demonstrated in one of the hospitals. The lowest level of hospital antimicrobial use, the lowest proportion of E. faecium and the lowest prevalence of resistance were observed in Reykjavik. The study showed a relatively low level of resistance in enterococci, as compared with most European countries and the USA. However, there were large differences between hospitals with regard to the relative proportion of E. faecium isolates, their susceptibility to ampicillin and gentamicin, as well as the prevalence of HLGR in E. faecalis isolates. This indicates a potential for further improvement of antibiotic policies, and possibly hospital infection control, to maintain the low resistance levels observed in these countries.     

72株D群肠球菌对19种抗生素的耐药性

目的了解本院临床D群肠球菌和高耐肠球菌的检出率及其耐药性。方法菌株鉴定采用法国梅里埃公司API系列产品，药敏试验采用K—B纸片扩散法。结果共检出72株D群肠球菌，其中尿标本分离48株，痰标本8株，腹腔渗出物10株，血标本4株，关节液2株。19种抗生素药敏试验结果显示，万古霉素和替考拉宁无一耐药，其次为呋喃坦丁（2．0％），氯霉素（29．6％），肠球菌高水平庆大霉素耐药率为56．0％，肠球菌高水平链霉素耐药率为65．0％。其余耐药率均大于50．0％。在试验中，笔者发现粪肠球菌比屎肠球菌的耐药率平均水平低。结论D群肠球菌的耐药率较高，是一种重要的院内感染菌，应长期进行耐药监控。     

Absence of synergistic activity between ampicillin and vancomycin against highly vancomycin-resistant enterococci.

The emergence of clinical enterococcal isolates resistant to both ampicillin and vancomycin is a cause of great concern, as there are few therapeutic alternatives for treatment of infections caused by such organisms. We evaluated the effects of the combination of ampicillin with vancomycin against vancomycin-resistant clinical enterococcal isolates. Using both the checkerboard technique and time-kill curves, we examined 28 strains of enterococci (17 Enterococcus faecalis and 11 Enterococcus faecium strains) with different levels of resistance to vancomycin. Of these, 15 strains were also highly gentamicin resistant, and 9 demonstrated resistance to ampicillin. Only seven strains of E. faecalis were inhibited synergistically by the combination of vancomycin with ampicillin, and even then, the concentrations of vancomycin at which synergism was demonstrated were above levels achievable in serum. None of the ampicillin-resistant isolates (all E. faecium) were inhibited synergistically at any concentration of the drugs. In no instance was bactericidal synergism observed, and in most cases the combination resulted in less killing than with ampicillin alone. Antagonism was not observed at clinically relevant concentrations. The results of this study suggest that the combination of vancomycin with ampicillin has little to offer against these emerging pathogens.     

Novel antibiotic regimens against Enterococcus faecium resistant to ampicillin, vancomycin, and gentamicin.

Enterococci have emerged as significant nosocomial pathogens. Enterococci with resistance to commonly used antibiotics are appearing more frequently. We encountered at our institution several infections caused by Enterococcus faecium with high-level resistance to ampicillin, vancomycin, and gentamicin. The optimal antibiotic therapy for serious infections with unusually resistant enterococci has not been established. Using time-kill studies, we tested the effectiveness of various antibiotic combinations against 15 isolates of multidrug-resistant enterococci. No antibiotic was consistently effective when used alone. The combination of ampicillin plus ciprofloxacin was bactericidal for the 12 isolates for which the ciprofloxacin MIC was < or = 8 micrograms/ml. The combination of ciprofloxacin plus novobiocin also demonstrated activity against these isolates. No combination was found to be bactericidal for the remaining three isolates, which were highly ciprofloxacin resistant. These antibiotic combinations may be important for the future treatment of serious infections caused by these resistant pathogens.     

肠球菌耐药现状调查及抗感染用药探讨

目的了解肠球菌尤其是对万古霉素耐药肠球菌（ＶＲＥ）和庆大霉素高水平耐药（ＨＬＧＲ）肠球菌的耐药状况,指导临床合理用药。方法对北京５家教学医院感染标本中分离出的１６１４株肠球菌,分别进行纸片扩散法药敏试验和β内酰胺酶测试,并以“ＷＨＯＮＥＴ４”软件对试验数据进行分析处理。结果ＶＲＥ和ＨＬＧＲ肠球菌分别占肠球菌感染标本总数的３．４％和５２．６％,产β内酰胺酶的肠球菌占５．８％;对常用抗生素的耐药率,屎肠球菌明显高于粪肠球菌,ＨＬＧＲ株明显高于低耐株;万古霉素和高浓度庆大霉素多重耐药株检出率为０．９％。结论肠球菌对临床常用的８种抗生素以万古霉素最敏感。对不同特征肠球菌感染应采取不同的治疗方案。     

医院感染肠球菌的临床分离及耐药性分析

目的 了解医院感染肠球菌的临床分离及其对常用抗生素的耐药性,指导临床合理用药,提高医院感染的治愈率.方法 对本院感染标本中分离出的136株肠球菌,进行常规分离和纸片扩散法进行药敏试验,并以"WHONET 5.5"软件对试验数据进行分析处理.结果 在136株肠球菌中,以粪肠球菌为主(77.94%),主要引起泌尿系感染.药敏试验结果显示:肠球菌对各种抗生素的耐药性差异有统计学意义,粪肠球菌对抗生素的耐药率最低是万古霉素(1.6%),最高是四环素(79.0%).屎肠球菌对大部分抗生素的耐药率明显高于粪肠球菌.结论 医院感染肠球菌属细菌常发生在免疫功能低下、有严重基础疾病、使用过侵袭性操作的患者, 肺部感染最常见.肠球菌对常用抗生素耐药率较高, 屎肠球菌的耐药性明显高于粪肠球菌.万古霉素敏感性高, 是治疗肠球菌感染的最佳抗生素.     

Vancomycin-resistant enterococci(VRE)

The incidence of Enterococcal nosocomial infection has increased since 1980s. Most Enterococci are intrinsically resistant to many kinds of antibiotics, therefore, therapeutic drugs for enterococal infectious disease are limited to a few antibiotics such as ampicillin, gentamicin and vancomycin. However, since the first report of penicillinase producing E. faecalis in 1983, ampicillin-resistant strains have been increasing, furthermore, these strains often associated with high-level resistance to aminoglycosides. The yearly usage of vancomycin increased because vancomycin was only effective drug against such resistant strains and worldwide spread of multidrug-resistant MRSA which vancomycin is only effective. However, High-level vancomycin-resistance strains of E. faecium were first isolated in England in 1986. In 1990s, VRE have been spreading all over the world, especially, the emergency of multidrug-resistant strains, which are resistant to high concentrations of ampicillin or gentamicin or to vancomycin in USA, brought serious therapeutic dilemmas. This review focuses on the background in emergence of VRE, the relation with use of avoparcin, is used for growth promotion in farm animals, the mechanism of resistance, and the prevention of the spread of vancomycin resistance.     

Bactericidal activities of antibiotics against vancomycin-resistant Enterococcus faecium blood isolates and synergistic activities of combinations.

The effects of teicoplanin (8 micrograms/ml), ampicillin (64 micrograms/ml), imipenem (32 micrograms/ml), and gentamicin (4 micrograms/ml), alone and in combination, against 13 unique blood isolates of vancomycin-resistance (MIC for 90% of isolates tested [MIC90], 512 micrograms/ml), teicoplanin-susceptible (MIC90, 2.0 micrograms/ml), ampicillin-resistant (MIC90, 128 micrograms/ml), and non-beta-lactamase-producing Enterococcus facium (vancomycin-resistant enterococci [VRE] isolates) were evaluated by time-kill studies. All 13 isolates exhibited high-level resistance to streptomycin; 7 isolates exhibited high-level gentamicin resistance (HLGR). After 24 h of incubation, ampicillin (64 micrograms/ml) combined with gentamicin (4 micrograms/ml) was bactericidal against three of the VRE isolates that did not display HLGR. Synergy between ampicillin and gentamicin was not observed against these isolates. Teicoplanin (8 micrograms/ml) alone was bactericidal at 24 h against five of six VRE isolates that lacked HLGR, but was not bactericidal against any HLGR VRE isolate at that time point. The addition of ampicillin (64 micrograms/ml) or imipenem (32 micrograms/ml) to teicoplanin did not significantly enhance the killing of HLGR VRE isolates as a group (P = 0.335). However, there was a trend toward improved killing of some HLGR VRE isolates by teicoplanin plus imipenem. Vancomycin (32 micrograms/ml) combined with ampicillin (64 micrograms/ml) was neither bactericidal nor synergistic against HLGR VRE isolates. Overall, bactericidal activity was attainable against 7 of 13 VRE isolates at 24 h.     

肠球菌属感染临床特点及耐药性研究

目的研究肠球菌属感染的临床特点及其耐药性,指导临床合理使用抗菌药物。方法采用回顾性调查方法对临床分离的924例肠球菌属相关资料进行统计分析。结果临床标本中肠球菌属在尿液中的分布最高,占71.32%;屎肠球菌与粪肠球菌对抗菌药物的耐药率不尽相同,万古霉素耐药菌株逐年增多。肠球菌属引起的院内感染病例占63.42%;60岁以上老年人占64.41%,所有患者均有较严重的基础病。结论肠球菌已是医院感染的重要致病菌,老年及免疫功能低下患者易感,以尿路感染最常见;肠球菌属对多种抗生素耐药,耐万古霉素肠球菌株明显增加。