Prevalence and characterization of vancomycin-resistant enterococci in chicken intestines and humans of korea

The prevalence, genotype for antibiotic resistance and antibiotic susceptibility of vancomycin resistant enterococci (VRE) were determined. And molecular typings of the Enterococcus faecium isolates were analyzed. Prevalence of VRE in chickens, healthy children and intensive care unit (ICU) patients was 41.6%, 7.9%, and 20.4%, respectively. Forty out of 54 isolates from chicken intestines, and 9 out of 11 from ICU patients were identified as Enterococcus faecium. Eleven out of 13 isolates from non-hospitalized young children were E. gallinarium. Twelve strains of E. faecalis were isolated from chicken intestines. The gene for the antibiotic resistance in E. faecium, and E. faecalis was vanA, while that in E. gallinarium was vanC1. E. faecium isolates were resistant to most of antibiotics except ampicillin and gentamicin. Molecular typing of the E. faecium strains obtained by pulse field gel electrophoresis and repetitive sequence-based PCR suggest that VRE transmit horizontally from poultry to humans, especially young children, via the food chains in Korea.     

Antimicrobial resistance of Enterococci in Lebanon

There is little information on the types of Enterococcus spp and their antibiotic resistance patterns in Lebanon. One hundred and fifty-three consecutive clinical enterococcal isolates collected between 1998 and 1999 were tested against 11 antimicrobial agents using disk diffusion and the Etest. The isolates were identified by conventional methods and API-Strep and were found to consist of Enterococcus faecalis (72.5%), Enterococcus faecium (22.9%), Enterococcus avium (3.2%) and Enterococcus gallinarum (1.3%). The percent of resistant strains of E. faecalis and E. faecium respectively were, ampicillin 0.9 and 14%, erythromycin 59% and 40%, tetracycline 72% and 34%, chloramphenicol 32 and 11%, rifampin 36% and 57%, ciprofloxacin, 23% and 34%, norfloxacin 22 and 8%. High level aminoglycoside (HLA) resistance was found in 19% E. faecalis and 9% E. faecium for gentamicin and 36% and 26% for streptomycin. Excellent correlation was observed between the high level disk tests and the Etest in the detection of HLA resistance but not with the regular disks. None of the isolates showed resistance to vancomycin or teicoplanin except for one E. gallinarum isolate which showed intermediate resistance (MIC 16 mg/l) to vancomycin. These variable antimicrobial rates of resistance suggest a surveillance programme for antimicrobial resistance in this country would be helpful to help control infection, guide empirical antibiotic therapy and implement a policy of antibiotic usage.     

Risk factors in enterococci isolated from foods in Morocco: Determination of antimicrobial resistance and incidence of virulence traits

A collection of enterococci isolated from meat, dairy and vegetable foods from Morocco including 23 Enterococus faecalis and 15 Enterococcus faecium isolates was studied. All isolates were sensitive to ampicillin, penicillin, and gentamicin. Many E. faecalis isolates were resistant to tetracycline (86.95%), followed by rifampicin (78.26% ciprofloxacin (60.87%), quinupristin/dalfopristin (56.52%), nitrofurantoin (43.47%), levofloxacin (39.13%), erythromycin (21.73%), streptomycin (17.39%), chloramphenicol (8.69%), vancomycin (8.69%), and teicoplanin (4.34%). E. faecium isolates showed a different antibiotic resistance profile: a high percentage were resistant to nitrofurantoin (73.33%), followed by erythromycin (66.60%), ciprofloxacin (66.66%), levofloxacin (60.00%), and rifampicin (26.66%), and only a very low percentage were resistant to tetracycline (6.66%). One isolate was resistant to vancomycin and teicoplanin. The incidence of virulence factors was much higher among E. faecalis isolates, especially for genes encoding for sex pheromones, collagen adhesin, enterococcal endocarditis antigen, and enterococcal surface protein. Isolates with multiple factors (both antibiotic resistance and virulence traits) were also more frequent among E. faecalis isolates, in which one isolate cumulated up to 15 traits. By contrast, several isolates of E. faecium had only very few unwanted traits as compared to only two isolates in E. faecalis. The high abundance of isolates carrying virulence factors and antibiotic resistance traits suggests that the sanitary quality of foods should be improved in order to decrease the incidence of enterococci.     

Antibiotic resistance among enterococcal strains isolated from clinical specimens

The distribution and resistance patterns of clinical isolates of enterococci from hospital patients were compared with those obtained from outpatients. Of 235 enterococcal isolates 212 (90.2%) were identified as Enterococcus faecalis and 23 (9.8%) as E. faecium. E. faecium occurred more frequently in specimens from hospitalized patients than from outpatients (P < 0.001). Over 90% of all E. faecalis isolates were susceptible to ampicillin. Resistance to ampicillin occurred in 66.7% of hospital strains of E. faecium. High-level resistance to gentamicin (MIC > 500 mg/l) was seen in 37.03% of inpatients' and in 11.5% of outpatients' E. faecalis isolates and in 76.2% of hospital isolates of E. faecium. High-level streptomycin resistance (MIC > 2000 mg/l) occurred in 52.8% of E. faecalis and 76.2% of E. faecium hospital isolates. There were no isolates resistant to vancomycin. The community acquired strains isolated from outpatients were more susceptible than isolates from hospitalized patients to all antimicrobial agents tested.     

天津市八家医院肠球菌临床分离株的耐药分析

目的：研究天津地区临床分离的肠球菌对常用抗生素的耐药情况，为临床合理选用抗生素提供科学依据。方法：收集天津市8家三级甲等医院于2001年2月-2002年2月分离的149株肠球菌，采用纸片扩散法(K-B法)进行药敏试验。结果：149株肠球菌感染中粪肠球菌73．8％，屎肠球菌16．1％。110株粪肠球菌耐药率较低的药物为万古霉素1．0％，氨苄西林38．6％，青霉素41．3％等。24株屎肠球菌耐药率较低的药物为万古霉素4．3％，氯霉素38．5％。结论：肠球菌耐药情况较为严重，应根据药敏试验合理使用抗菌药物。     

Bacterial resistance to antimicrobials in urinary isolates

Escherichia coli accounted for about 80% of organisms in uncomplicated urinary tract infections (UTIs), followed by Staphylococcus spp. especially Staphylococcus saprophyticus, and Proteus mirabilis. Against E. coli isolates from patients with uncomplicated UTI, faropenem was the most effective. Up to 1999, fluoroquinolone-resistant isolates were not observed in patients with uncomplicated UTI, but in 2001 fluoroquinolone-resistant E. coli isolates emerged and accounted for about 8%. Various types of organisms were isolated in patients with complicated UTI. Enterococcus faecalis, E. coli, and Pseudomonas aeruginosa were the three most frequent organisms isolated. These three organisms accounted for 44.6%. Amongst oral agents, faropenem showed the lowest rate of resistance against E. coli followed by cephems. The rates of highly fluoroquinolone-resistant and cefpodoxime-resistant E. coli isolates increased rapidly from 1998 to 2001. Fluoroquinolone-resistant P. aeruginosa isolates accounted for about 40% in 2001. Against this species, amikacin was the most effective antimicrobials among all agents tested. About 17% of Pseudomonas were resistant to carbapenem. Eight milligram per litre of ampicillin inhibited all E. faecalis isolates; about 60% of Enterococcus faecium were resistant to ampicillin. The rates of levofloxacin-resistant isolates of E. faecalis and E. faecium were 38 and 97% respectively. UTIs caused by vancomycin resistant enterococci (VRE) are rare in Japan.     

肠球菌感染现状及其耐药性的变迁

目的了解肠球菌感染现状及其耐药性的变迁,为预防和治疗肠球菌感染提供依据。方法收集孙逸仙纪念医院2009～2011年患者标本中分离的肠球菌属,按照CLSI推荐的方法和判断标准,用纸片扩散法进行药敏试验,用WHONET5.3软件和SPSS13软件进行统计分析。结果近3年从各种临床标本中共分离出1016株肠球菌,粪肠球菌587株（57.78%）,屎肠球菌370株（36.42%）。标本主要来源于尿液（21.26%）、痰液（17.42%）、体液及胆汁（17.22%）。粪肠球菌对氨苄西林/舒巴坦、氨苄西林、亚胺培南耐药率较低,分别为0%、7.5%、7.5%左右,对高浓度庆大霉素耐药率为50%左右;屎肠球菌耐药性明显高于粪肠球菌,对氨苄西林/舒巴坦耐药率超过90%,对高浓度庆大霉素耐药率超过70%,但对喹奴普汀/达福普汀仅为0.96%。肠球菌属细菌对利奈唑胺、万古霉素、替考拉宁仍最敏感（耐药率≤5%）,2010及2011年分别分离出耐万古霉素屎肠球菌1株及8株,耐利奈唑胺的粪肠球菌6株及4株,2011年分离出耐替考拉宁的屎肠球菌5株。结论万古霉素、替考拉宁和利奈唑胺是对肠球菌抑菌率最高的药物,万古霉素耐药肠球菌发生率有增加趋势,特别是出现了个别利奈唑胺耐药的肠球菌菌株,因此,监测肠球菌属的耐药状况对指导临床治疗具有重要意义。     

2396株肠球菌属细菌的临床分布及耐药性变迁

摘要：目的 探讨2396株肠球菌属细菌的临床分布特点及耐药情况,为临床抗感染工作提供有力的参考依据。方法 回顾性分析本院2015-2020年住院患者临床分离的肠球菌资料,梳理出肠球菌临床分布及对不同抗菌药物的耐药情况,运用统计学方法分析并总结。结果 2396株肠球菌中屎肠球菌874株,粪肠球菌1204株,鹑鸡肠球菌123株,铅黄肠球菌76株,鸟肠球菌70株;分离标本来自于尿液1070株(占44.65%),胆汁747株(占31.17%),引流液263株(占10.97%);2396株肠球菌在外科共检出1662株(占69.36%),内科462株(占19.28%)。屎肠球菌对利奈唑胺、喹努普汀/达福普汀耐药率低于10%;对替加环素、替考拉宁、万古霉素耐药率低于5%;高浓度庆大霉素、高浓度链霉素耐药率(P<0.001)均呈现逐年下降趋势。粪肠球菌对环丙沙星、氨苄西林耐药率低于23%;铅黄肠球菌对呋喃妥因耐药率均低于5%。粪肠球菌对四环素、喹努普汀/达福普汀的6年整体耐药率高于屎肠球菌。结论 检出2396株肠球菌以屎肠球菌和粪肠球菌为主,主要来自尿液、胆汁和引流液。6年来粪肠球菌对临床常用抗菌药物的耐药率明显低于屎肠球菌,利奈唑胺、替加环素及万古霉素耐药菌已出现,应引起重视,督促临床合理选择抗菌药物。     

120株肠球菌耐药分析及药物选择

目的观察肠球菌属的临床分布特点及耐药状况。方法收集医院2011年1月～6月培养检出的120株肠球菌属,分析其在各种临床标本中的分布特征和耐药状况。结果检出粪肠球菌63株(52.5%)、屎肠球菌48株(40.8%)、其他肠球菌8株(6.7%)。其中尿液中检出58株肠球菌(48.3%)。屎肠球菌的耐药率普遍较粪肠球菌高。未检出耐万古霉素的尿肠球菌和粪肠球菌,检出耐利奈唑胺粪肠球菌2株。结论肠球菌属感染以粪肠球菌和屎肠球菌为主,肠球菌属中各种菌对抗菌药物的耐药性有差异,应在抗菌药物敏感试验指导下并结合感染部位合理地选用抗菌药物。     

Occurrence of the Van Genes inEnterococcus faecalis andEnterococcus faecium from clinical isolates in Korea

Enterococcus faecalis and Enterococcus faecium isolated from Korea patients in 1998 and 2005 were tested for susceptibility to nine different antimicrobial agents, including vancomycin and teicoplanin. Polymerase chain reaction (PCR) was used for the detection of several vancomycin resistance genes such as vanA ('high level'), vanB ('moderate high level'), vanC1 and vanC2 ('low level'). Both E. faecalis and E. faecium exhibited a resistance of 80% and more than 60% to synercid and mupirocin, respectively. Moreover, an average of 76% of all isolates was resistant to ciprofloxacin, gentamicin, lincomycin, cefotaxime, and meropenem, confirming the multiple drug resistance of most of the isolates. No resistance to vancomycin or teicoplanin was observed in the 1998 E. faecalis and E. faecium isolates. However, the 2005 E. faecalis and E. faecium isolates exhibited resistance of 16% and 12% to vancomycin and teicoplanin, respectively. In addition, vanA gene was detected in 4 strains of 2005 E. faecium isolates, thus showing a high resistance to vancomycin. No other vancomycin resistance genes, including vanB, vanC1, and vanC2, were found in our isolates. In this study, we compared the occurrence of antimicrobial resistance and the presence of specific resistance genes in E. faecalis and E. faecium. The results showed that the 2005 isolates were usually more resistant than the 1998 isolates.     

老年患者肠球菌感染的临床分布特点及耐药性对比分析

目的 了解老年患者肠球菌感染的临床分布特点及耐药性,为临床合理用药提供参考依据。 方法 收集中国医科大学附属盛京医院2016年1月至12月期间246例老年患者感染标本中分离出的肠球菌,采用回顾性分析方法,统计临床数据并进行分析。 结果 共检出278株肠球菌,其中粪肠球菌84例,占30.22％,屎肠球菌182 例,占65.47％。两类肠球菌均主要分离于尿液、全血、引流液和胆汁中。屎肠球菌主要分离于重症监护室、普通外科、泌尿外科和呼吸内科,而粪肠球菌主要分离于普通外科和泌尿外科。屎肠球菌对于红霉素,莫西沙星,环丙沙星,左氧氟沙星,青霉素G,氨苄西林的耐药率高达90%以上。而粪肠球菌对于上述抗生素(除红霉素外)的耐药率均低于50%。粪肠球菌对四环素,喹努普汀/达福普汀和利福平的耐药率高于屎肠球菌。两者对于克林霉素的耐药率均高达100%。共检测出耐万古霉素的屎肠球菌两株以及耐利奈唑胺的屎肠球菌和粪肠球菌各一株。 结论 老年患者中屎肠球菌对多种抗菌药物的耐药率显著高于粪肠球菌,并且已经出现了耐万古霉素和利奈唑胺的菌株,应根据药敏结果合理选用抗菌药物,提高治疗效果。     

Antimicrobial resistance and the mechanisms implicated in faecal enterococci from healthy humans, poultry and pets in Portugal

Antimicrobial resistance and the mechanisms implicated were studied in 440 enterococci (227 Enterococcus faecium, 177 Enterococcus faecalis, 32 Enterococcus hirae and 4 Enterococcus durans) recovered from 220 faecal samples of healthy humans, poultry and pets in Portugal. Higher levels of resistance were detected for ampicillin, tetracycline, erythromycin and chloramphenicol in poultry isolates (10.5%, 97%, 87.5% and 16%, respectively) compared with human isolates (0%, 26%, 31.5% and 5%, respectively); intermediate levels of resistance for these antibiotics were found in pet isolates. Thirty-three per cent of the E. faecium isolates of poultry origin showed quinupristin/dalfopristin resistance. High-level resistance to gentamicin or streptomycin was detected in 1-7% of isolates in our series of enterococci. The aac(6')-aph(2'), aph(3')-IIIa, erm(B) and tet(M) genes were demonstrated in most of the gentamicin-, kanamycin-, erythromycin- and tetracycline-resistant isolates, respectively. The vat(E) gene was found in 39% of the quinupristin/dalfopristin-resistant E. faecium isolates of poultry origin.     

我院2006～2008年粪肠球菌和屎肠球菌耐药性分析

目的:监测我院2006～2008年肠球菌中粪肠球菌株和屎肠球菌株的耐药性,为临床合理应用抗菌药物提供依据。方法:采用K-B纸片法对分离鉴定后的肠球菌进行药敏试验,应用WHONET5软件统计粪肠球菌和屎肠球菌的耐药率。结果:万古霉素是敏感性最高的抗菌药物。粪肠球菌对青霉素、高浓度庆大霉素、环丙沙星、利福平的耐药率较低,而屎肠球菌对高浓度链霉素、四环素、氯霉素和奎奴普丁/达福普汀的耐药率较低。结论:粪肠球菌和屎肠球菌均呈多重耐药,临床用药应结合药敏试验结果,合理选择抗菌药物。     

我院227株肠球菌细菌耐药性分析

目的:了解肠球菌在临床标本中的分布及对常用抗菌药物的耐药现状。方法:对临床标本中分离出的细菌进行系统检验,采用K-B纸片法对分离鉴定后的肠球菌进行药物敏感性试验。结果:肠球菌可在临床常见的多种标本中检出,粪肠球菌(44·1%)与屎肠球菌(37·9%)常见。对常用抗菌药物的耐药性,粪肠球菌和屎肠球菌之间的差异无统计学意义。万古霉素是敏感性最高的抗菌药物。青霉素、氨苄青霉素和呋喃妥因对粪肠球菌具有较好的抗菌活性。屎肠球菌对除糖肽类以外的所有临床常用抗菌药物显示高水平耐药。结论:临床医师应关注临床常见病原菌的耐药性,动态监测肠球菌的耐药状况对指导临床治疗具有重要意义。     

某院2016-2019年儿童导管相关性尿路感染病原菌分布和耐药性分析

目的:为抗菌药物经验性治疗儿童导管相关性尿路感染(CAUTI)提供参考.方法:回顾性收集2016-2019年苏州大学附属儿童医院住院患儿导管相关性尿路感染尿培养分离的病原菌119株,统计分析病原菌分布情况和药敏试验结果.结果:革兰阳性菌86株(72.3％),革兰阴性菌27株(22.7％),真菌6株(5.0％).常见病原...     

肠球菌属细菌医院感染的临床及耐药性分析

目的探讨肠球菌属细菌所致医院感染的危险因素、临床特点及耐药情况,为临床治疗肠球菌感染提供指导。方法收集确诊为肠球菌医院感染病例的临床资料,分析发病的危险因素及临床特点,对分离到的菌株进行药物敏感性测定。结果49例肠球菌医院感染患者均存在着严重的基础疾病,69.39%的患者接受过侵袭性操作,感染部位以肺部最多见。分离出52株肠球菌,包括粪肠球菌40株、屎肠球菌9株和其他肠球菌3株。肠球菌属对红霉素、喹诺酮类抗菌药物和利福平普遍耐药,而屎肠球菌对抗菌药物的耐药性普遍高于粪肠球菌,尤其对氨苄西林和青霉素G的耐药率明显高于粪肠球菌(P<0.01),未发现对万古霉素耐药的菌株。结论肠球菌属细菌医院感染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。肠球菌对常用抗菌药物耐药率较高,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选择。     

自贡地区尿培养中分离菌的临床分布及耐药性分析

目的 了解自贡地区泌尿道感染病原菌的临床分布及耐药情况，为临床合理使用抗菌药物提供参考。方法 收集 2017 年自贡地区所有三级综合医院尿培养阳性菌株及药敏结果，采用WHONET 5.6 及SPSS 19.0 软件对数据进行分析。结果 共分离出2063 株细菌，其中其中革兰阳性菌占18.5%，革兰阴性菌占81.5%。前5 位细菌中，大肠埃希菌排列第一，占53.4%， 其次是肺炎克雷伯菌(9.3%)、屎肠球菌(6.3%)、粪肠球菌(6.2%) 和铜绿假单胞菌(4.6%)。前5 位分离菌的耐药结果为：大肠埃 希菌及肺炎克雷伯菌对哌拉西林/ 三唑巴坦、头孢替坦、厄他培南、亚胺培南及阿米卡星的耐药率均较低(<5%)，其中产超广谱β- 内酰胺酶(ESBLs) 菌的检出率分别为50.4% 和35.4%；屎肠球菌对青霉素、氨苄西林、环丙沙星、左氧氟沙星、莫西沙星及红 霉素耐药率高(>90%)，但对奎奴普丁/ 达福普汀及万古霉素的耐药率低(<10%)，对利奈唑胺的耐药率为0；而粪肠球菌对青霉素、 氨苄西林、呋喃妥因及利奈唑胺耐药率低(<5%)，对万古霉素的耐药率为0；铜绿假单胞菌对常见抗菌药物耐药率较低，其中亚 胺培南的耐药率为16.0%，而阿米卡星的耐药率最低，为3.2%。不同性别间病原菌谱特点为：男性中前5 位细菌为大肠埃希菌、 肺炎克雷伯菌、粪肠球菌、铜绿假单胞菌和屎肠球菌，而女性为大肠埃希菌、肺炎克雷伯菌、屎肠球菌、粪肠球菌和奇异变形菌。 病原菌的年龄分布以71~80 岁和61~70 岁为主，未成年组前3 位细菌为大肠埃希菌、屎肠球菌和肺炎克雷伯菌，而成年组和老年 组前3 位细菌均为大肠埃希菌、肺炎克雷伯菌和粪肠球菌。不同性别间大肠埃希菌和肺炎克雷伯菌对氨苄西林/ 舒巴坦、头孢唑林、 头孢他啶、头孢曲松、氨曲南、妥布霉素、环丙沙星及左氧氟沙星的耐药率差异均有统计学意义(P<0.05)，而屎肠球菌、粪肠球 菌和铜绿假单胞菌对常见抗菌药物的耐药率无性别差异(P>0.05)。结论 自贡地区泌尿道感染病原菌以大肠埃希菌为主，不同性别、 不同年龄组间患者的病原菌谱及耐药谱存在差异。本地区屎肠球菌耐药严重，应尽早目标性抗感染治疗。     

粪肠球菌和屎肠球菌的耐药性分析

目的了解粪肠球菌和屎肠球菌对抗感染药物的耐药性,为临床提供治疗依据。方法对住院及门诊患者送检样本中培养分离出281株肠球菌（粪肠球菌112株,屎肠球菌169株）的感染分布与耐药情况进行分析。采用稀释法进行药物敏感试验,结果按美国临床实验室标准化研究所标准判定。结果屎肠球菌对青霉素G的耐药率最高（93．7％）,其次为红霉素、氨苄西林和环丙沙星。粪肠球菌对奎奴普丁／达福普汀耐药率最高为（74．0％）,其次为高浓度庆大霉素、四环素、红霉素和环丙沙星。粪肠球菌和屎肠球菌对利奈唑胺和万古霉素的耐药率均低于2．0％,替考拉宁的耐药率最低（均为0）。结论粪肠球菌和屎肠球菌对不同抗感染药物的耐药率有较大差异,在抗感染治疗前应先做细菌培养和药物敏感试验,依据报告结果合理选用抗感染药物。     

2018年四川省细菌耐药监测网尿液标本的病原菌分布及耐药性分析

总结2018年四川省细菌耐药监测网成员单位临床尿液标本中分离病原菌的分布与耐药状况。方法 对 83所四川省细菌耐药监测网成员单位临床尿液标本中分离病原菌的药敏数据进行分析,依据美国实验室与临床标准化协会 (CLSI)2018版标准判断药物敏感性,用WHONET5.6软件进行数据分析。结果 共获31930株临床分离病原菌,革兰阴性菌占 76.9%(24560/31930),革兰阳性菌占23.1%(7370/31930)。男性标本占44.6%(14250/31930),女性标本占55.4%(17680/31930)。男 性和女性排在前4位病原菌为大肠埃希菌、屎肠球菌、肺炎克雷菌、粪肠球菌,分别占50.9%、10.2%、7.9%和5.5%;排在第五 位的病原菌男性为铜绿假单胞菌,占1.9%;女性为奇异变形菌,占1.5%,与我省2017年相比无明显变化,与全国相比,有明显 不同。大肠埃希菌在碳青酶烯类男性和女性耐药率分别为1.8%和1.0%,处于低水平,大肠埃希菌对喹诺酮类的耐药率高达50% 以上,与2017年的耐药率相比,基本无明显变化。肺炎克雷伯菌在碳青酶烯类男性和女性耐药率分别为8.4%和7.5%,与2017年 耐药率相比,有明显上升。男性和女性在肠球菌对万古霉素、利奈唑胺、替考拉宁的耐药率均低于3.5%,屎肠球菌的耐药率明 显高于粪肠球菌。铜绿假单胞菌在男性和女性对亚胺培南、美罗培南耐药率分别为10.6%、10.8%和9.7%、10.6%。分离自男性 尿液标本中病原菌对抗菌药物的耐药率大多高于女性尿液标本。结论 我省尿路感染病原菌主要以大肠埃希菌和肠球菌为主, 病原菌耐药率呈缓慢增长趋势,个别耐药菌上升较明显。应重视细菌耐药监测,应根据药敏结果合理选择抗生素,减少耐药菌 株的产生。     

2020年蚌埠医学院第一附属医院细菌耐药性监测

摘要：目的 通过对2020年蚌埠医学院第一附属医院临床分离菌分布及对抗菌药物的耐药性分析,为临床合理选择抗菌药物提供参考。方法 采用自动化仪器法、纸片扩散法(K-B法)或E-test方法对我院2020年临床分离的菌株进行药敏试验,按CLSI 2020版标准判断结果,WHONET5.6软件统计分析数据。结果 2020年我院临床共分离4209株细菌,其中革兰阳性菌1121株(26.6%,1121/4209),革兰阴性菌3088株(73.4%,3088/4209)株,前10位分离菌分别为：大肠埃希菌1093株(26.0%)、肺炎克雷伯菌565株(13.4%)、凝固酶阴性葡萄球菌402株(9.6%)、鲍曼不动杆菌354株(8.4%)、铜绿假单胞菌345株(8.2%)、金黄色葡萄球菌313株(7.4%)、奇异变形杆菌132株(3.1%)、屎肠球菌122株(2.9%)、粪肠球菌94株(2.2%)和阴沟肠杆菌63株(1.5%)。金黄色葡萄球菌和凝固酶阴性葡萄球菌中耐甲氧西林菌株的检出率分别为43.1%和66.2%,未检出耐万古霉素和利奈唑胺菌株。肠球菌属细菌中以屎肠球菌和粪肠球菌为主,屎肠球菌对大多数测试抗菌药物的耐药率高于粪肠球菌,检出少数耐万古霉素和利奈唑胺药的肠球菌。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶(ESBLs)菌株占各自菌的63.1%和31.2%,肺炎克雷伯菌亚胺培南和厄他培南耐药率分别为26.7%和26.4%,较我院2017年有所下降(P<0.01),其余肠杆菌目细菌对碳青霉烯类抗生素耐药率均小于10%。铜绿假单胞菌对亚胺培南耐药率为34.2%,对头孢吡肟、哌拉西林/他唑巴坦、氨曲南、左氧氟沙星和阿米卡星的耐药率均小于30%。鲍曼不动杆菌对阿米卡星的耐药率为31.0%,亚胺培南耐药率为89.5%。流感嗜血杆菌产β-内酰酶检出率为60.7%。结论 临床分离菌对常见抗菌药物耐药情况较严重,耐碳青霉烯类肺炎克雷伯菌的检出率有所下降,但仍值得警惕,应重视细菌耐药监测,继续加强医院感染的防控,合理使用抗菌药物。