临床分离革兰阳性球菌对去甲万古霉素的敏感性

目的评价去甲万古霉素对临床分离革兰阳性球菌的体外抗菌活性。方法琼脂对倍稀释法测定去甲万古霉素对3 011株临床分离菌的体外抗菌活性,并与有关抗菌药物进行比较。结果去甲万古霉素对革兰阳性球菌包括葡萄球菌属、链球菌属、肠球菌属等临床常见的需氧革兰阳性球菌均显示高度的抗菌活性,包括其中的甲氧西林耐药金黄色葡萄球菌、青霉素耐药肺炎链球菌和多重耐药的屎肠球菌等。其对革兰阳性菌的抗菌活性与同类药万古霉素和替考拉宁相仿;亦与利奈唑胺相近。除对万古霉素耐药的30株肠球菌对去甲万古霉素耐药,示与万古霉素交叉耐药外,未见其他革兰阳性球菌对去甲万古霉素耐药株。结论去甲万古霉素对临床重要的革兰阳性球菌具有高度的抗菌活性,其抗菌活性与万古霉素、替考拉宁等同类药相仿。提示该药仍可作为治疗上述敏感细菌所致感染的可选药物之一。     

耐甲氧西林金黄色葡萄球菌及其对万古霉素耐药的研究进展

<正>随着抗菌药物的滥用,细菌耐药现象日趋严重,尤其是革兰阳性致病菌,如金黄色葡萄球菌,凝固酶阴性葡萄球菌和肠球菌,并导致多重耐药菌株(如耐甲氧西林金黄色葡萄球菌,MRSA)的产生。临床上治疗MRSA的首选对策就是万古霉素。但是万古霉素的不合理使用,进一步导致耐万古霉素菌株或者万古霉素中介的菌株产生。所以鉴别MRSA     

2011年四川省肿瘤医院细菌耐药性监测

目的了解2011年四川省肿瘤医院临床分离株对常用抗菌药物的耐药性.方法采用 MIC 法对1582株临床分离株进行药敏试验.按美国临床实验室标准化协会2009版判读结果.结果1582株临床分离株中革兰阳性球菌占10.1%(160/1582),革兰阴性杆菌占89.9%(1422/1582).耐甲氧西林金黄色葡萄球菌(MR‐SA)的检出率占金黄色葡萄球菌的26.1%.葡萄球菌中甲氧西林耐药株对β‐内酰胺类抗菌药物和其他测试药的耐药率显著高于甲氧西林敏感株,未发现万古霉素和利奈唑胺耐药株.肠球菌属中屎肠球菌对多数测试药物的耐药率高于粪肠球菌,出现1株耐万古霉素菌株,无利奈唑胺耐药株.革兰阴性肠杆菌中,大肠埃希菌和克雷伯菌属产ESBLs 株分别为66.5%和21.2%.产 ESBLs 菌株对大多β‐内酰胺类抗菌药物高度耐药.亚安培南对肠杆菌科细菌抗菌活性最强.出现了较多的多重耐药鲍曼不动杆菌.结论该院细菌耐药性较2010年有增长趋势,尤其出现了耐万古霉素的肠球菌且多重耐药鲍曼不动杆菌显著增多,应引起注意,并及早采取防控措施.     

多重耐药菌医院感染预防与控制技术指南(试行)

多重耐药菌(MDRO)主要是指对临床使用的三类或三类以上抗菌药物同时呈现耐药的细菌.常见MDRO包括耐甲氧西林金黄色葡萄球菌(MRSA)、耐万古霉素肠球菌(VRE)、产超广谱β-内酰胺酶(ESBLs)细菌、耐碳青霉烯类抗菌药物肠杆菌科细菌[CRE,如产Ⅰ型新德里金属β-内酰胺酶(NDM-1)或产碳青霉烯酶(KPC)的肠杆菌科细菌]、耐碳青霉烯类抗菌药物鲍曼不动杆菌(CR-AB)、多重耐药/泛耐药铜绿假单胞菌(MDR/PDR-PA)和多重耐药结核分枝杆菌等.     

医院感染革兰氏阳性球菌的分布与耐药性分析

目的对临床分离的革兰氏阳性球菌的分布及耐药性进行分析,为指导临床合理使用抗菌药物提供依据。方法用Walkaway 40全自动细菌鉴定仪,对临床分离的革兰氏阳性球菌进行鉴定,并进行耐药试验以及统计学分析。结果从医院内感染患者分离出革兰氏阳性球菌242株。葡萄球菌189株(78.10%),其中金黄色葡萄球菌97株(40.08%);耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为55.67%和89.89%。肠球菌45株(18.60%),其中屎肠球菌29株,粪肠球菌16株,除氯霉素、四环素和喹奴普汀/达福普汀外,粪肠球菌对其他抗菌药物的敏感率高于屎肠球菌。未发现对万古霉素和利奈唑胺耐药的葡萄球菌和肠球菌。结论医院内感染的革兰氏阳性球菌主要以金黄色葡萄球菌为主,多数细菌多重耐药现象明显;糖肽类抗菌药物对革兰氏阳性球菌仍保持高度的抗菌活性。     

220株肠球菌的分布及耐药性研究

目的 调查重庆市某医院肠球菌属细菌的临床分布及对常见抗菌药物的耐药性.方法 采集临床各科送检的标本,进行肠球菌细菌的分离和培养,使用Vitek-Compact系统对肠球菌细菌进行鉴定,采用仪器法检测抗菌药物的MIC值,并根据CLSI的指导原则判定细菌的耐药性.结果 共分离到220株非重复肠球菌,最常见菌种为粪肠球菌95株(43.2%)、屎肠球菌84株(38.2%)和鹑鸡肠球菌32株(14.5%).药敏试验结果表明,屎肠球菌的总体耐药率高于粪肠球菌;肠球菌属对四环素、红霉素、庆大霉素的耐药率较高,对万古霉素、利奈唑胺保持高度敏感性.结论 肠球菌感染以屎肠球菌和粪肠球菌为主,可引起多部位感染,且对临床常用抗菌药物严重耐药.     

耐甲氧西林金黄色葡萄球菌临床耐药性分析

目的 为预防和控制医院感染的发生,对耐甲氧西林金黄色葡萄球菌的临床分布和耐药性进行分析.方法 使用ATB细菌鉴定分析仪进行细菌鉴定,用纸片扩散法鉴定耐甲氧西林金黄色葡萄球菌,药敏试验用K-B法.结果 在各临床科室中,由耐甲氧西林金黄色葡萄球菌引起的医院感染,ICU的比例最高,下呼吸道是最常见的感染部位,52株耐甲氧西林金黄色葡萄球菌对多种抗菌药物耐药,没有发现耐万古霉素菌株.结论 由耐甲氧西林金黄色葡萄球菌引起的医院感染以ICU病人最多见,以下呼吸道感染为主,耐甲氧西林金黄色葡萄球菌除对万古霉素敏感外对多种抗菌药物耐药.因此,临床医生要合理使用抗菌药物.     

2012年度某院患者无菌体液耐药性监测的调查

目的 了解2012年度该院患者无菌体液的细菌分布和对抗菌药物的耐药性.方法 对临床送检的无菌体液标本按常规进行病原菌分离,采用Vitek2-Compact系统和ATB Express系统进行鉴定,测定抗菌药物的最低抑菌浓度（MIC）值,采用纸片扩散法（K-B）进行微生物敏感性试验.应用WHONET 5.6软件进行数据分析.结果 分离菌株556株,革兰阴性菌316株（57%）,革兰阳性菌226株（40%）.常见细菌分别为大肠埃希菌、凝固酶阴性葡萄球菌、肺炎克雷伯菌、粪肠球菌、屎肠球菌、鲍曼不动杆菌、铜绿假单胞菌.大肠埃希菌、肺炎克雷伯菌的检出率分别为53.3%和21.1%;检出9株金黄色葡萄球菌,其中,耐甲氧西林金黄色葡萄球菌（66%）;耐甲氧西林凝固酶阴性葡萄球菌（74%）.未发现对万古霉素和利奈唑胺耐药的葡萄球菌.未发现对万古霉素耐药的肠球菌属细菌.大肠埃希菌、肺炎克雷伯菌对碳青酶烯类耐药的检出率分别为3.8%和3.8%.结论 及时监测病原菌的菌群种类、分布和耐药变迁以指导临床合理、规范地使用抗菌药物.     

尿路感染的病原菌分布及耐药性分析

目的探讨医院内尿路感染病原菌分布情况及耐药特征,为临床合理使用抗菌药物提供依据。方法分析2007～2009年625例尿液培养阳性的尿路感染病原菌分布及其对抗菌药物的耐药性。结果尿路感染病原菌以革兰阴性杆菌为主(68.1%),革兰阳性球菌为17.3%,真菌为14.6%;检出率分别为产ESBLS细菌43.1%、耐甲氧西林金黄色葡萄球菌(MRSA)83.3%、氨基糖苷类耐药肠球菌(HLAR)62.8%,未发现万古霉素耐药肠球菌(VRE)菌株。结论革兰阴性杆菌是尿路感染的主要病原菌,病原菌的耐药率呈上升趋势;重视病原菌的监测和耐药性分析,对指导临床合理使用抗菌药物,控制医院感染具有重要意义。     

2013年上海市青浦地区革兰阳性菌耐药性监测

目的了解2013年上海市青浦地区革兰阳性菌细菌耐药性监测结果,为临床合理使用抗菌药物提供依据。方法采用自动化仪器对青浦地区2所医院临床分离的革兰阳性菌进行药敏试验,采用CLSI 2014年版标准判断结果。结果 315株革兰阳性菌中,肠球菌属细菌、金黄色葡萄球菌(金葡萄)和凝固酶阴性葡萄球菌分别占40.3%(127/315)、36.5%(115/315)、20.3%(64/315)。耐甲氧西林金葡菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为48.7%和82.8%。甲氧西林耐药株对临床常用抗菌药物的耐药率均高于甲氧西林敏感株。葡萄球菌属和链球菌属细菌中未发现万古霉素和利奈唑胺耐药株。发现1株万古霉素耐药屎肠球菌和2株粪肠球菌。结论细菌耐药性仍对临床构成严重威胁,应引起临床严重关注。     

儿科血培养标本分离葡萄球菌耐药性分析

目的 了解葡萄球菌感染的状况及对常用抗菌药物的耐药性,为临床用药提供参考.方法 从该院儿科血培养中分离的葡萄球菌,用K-B法测定其对抗菌药物的敏感性,所有数据用WHONET5.4软件进行分析.结果 共检出葡萄球菌136例,其中金黄色葡萄球菌19例,凝固酶阴性葡萄球菌117例.耐甲氧西林葡萄球菌的检出率为30.1%,万古霉素对葡萄球菌有很好的敏感性,未发现耐药菌株,对其他类型的抗菌药物均有不同程度的耐药.金黄色葡萄球菌的耐药率明显高于凝固酶阴性葡萄球菌.结论 葡萄球菌对青霉素以及头孢类的耐药率太高而不宜用于临床治疗,治疗葡萄球菌引起的感染应根据药敏试验结果用药,并尽量减少万古霉素的使用,避免耐药菌株的产生.     

Antimicrobial-resistant gram-positive bacteria in PD peritonitis and the newer antibiotics used to treat them.

The incidence of resistant gram-positive bacteria in nosocomial and, more recently, community-acquired infections is increasing. Staphylococci, because of their natural habitat on the skin, have always been the leading cause of peritonitis in patients receiving peritoneal dialysis (PD). These organisms have demonstrated a remarkable ability to develop resistance to antibiotics, first with penicillin, then antistaphylococcal penicillins (methicillin-resistant Staphylococcus aureus), and more recently, strains expressing resistance to vancomycin (vancomycin-intermediate and vancomycin-resistant S. aureus) have emerged. Enterococci are normal inhabitants of the gastrointestinal tract and occasionally cause PD peritonitis. In the past 15 years, vancomycin-resistant enterococci have emerged as significant pathogens in many areas. In the past 5 years, novel antibiotics that have activity on gram-positive bacteria, including vancomycin-resistant strains, have become available. The problem of resistant gram-positive bacteria in PD peritonitis, their therapy, and the role of these newer agents, quinupristin/dalfopristin, linezolid, and daptomycin, are reviewed.     

2006-2010年浙江省萧山地区金黄色葡萄球菌临床分离与耐药变迁

目的 调查医院金黄色葡萄球菌(SAU)临床分离和分布情况及其对常用抗菌药物的耐药率,分析SAU耐药性变迁,并比较儿科组和重症监护病房(ICU)、耐甲氧西林金黄色葡萄球菌(MRSA)和甲氧西林敏感金黄色葡萄球菌(MSSA)耐药率,为临床合理使用抗菌药物提供依据。 方法 对浙江萧山医院2006年1月至2010年12月检出的SAU药敏结果回顾性分析。 结果 共检出SAU 857株,菌株的主要来源为痰213株(24.9%)、脓液189株(22.1%)、泌尿生殖道分泌物166株(19.4%);菌株分布前3位的科室是妇产科165株(19.3%)、儿科155株(18.1%)、ICU 103株(12.0%);其中MRSA 252株(29.4%)。SAU对利奈唑胺、万古霉素和呋喃妥因具有很高的敏感性,未检出万古霉素耐药株;氨苄西林/舒巴坦和莫西沙星的耐药率呈上升趋势;MRSA 对青霉素、苯唑西林、头孢唑林、氨苄西林/舒巴坦、庆大霉素、利福平、左旋氧氟沙星、莫西沙星、呋喃妥因、克林霉素、红霉素和四环素耐药率都明显高于MSSA 耐药率,差异有统计学意义(PP结论 MRSA检出率升高,应加强对SAU检测及其耐药性监测;通过分析SAU耐药率的变迁,有利于采取措施控制医院内MRSA的流行和指导临床用药。     

In vitro activity of LY333328, an investigational glycopeptide antibiotic, against enterococci and staphylococci.

The in vitro activities of LY333328 were compared with those of vancomycin, teicoplanin, and quinupristin-dalfopristin (Synercid) against 219 strains of enterococci and staphylococci, including vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus. MICs and MBCs were determined by a microtiter dilution protocol. LY333328 demonstrated superior activity against vancomycin-resistant enterococci and was the only antibiotic which was bactericidal. Its potency was comparable or superior to those of other antibiotics tested against methicillin-resistant staphylococci.     

Staphylococcus aureus strains that are hypersusceptible to resistance gene transfer from enterococci

We identified naturally occurring Staphylococcus aureus mutants of the restriction modification pathway SauI, including bovine lineage ST151. In a model of vancomycin resistance transfer from Enterococcus faecalis, ST151 isolates are 500 times more susceptible than human S. aureus isolates. The eradication of "hyperrecipient" strains may reduce the evolution of vancomycin-resistant S. aureus.     

New therapeutic agents for resistant Gram-positive infections

Gram-positive bacteria are an increasingly common cause of community acquired and nosocomial infections, and their resistance to antibiotics is increasing. The recent reports from several continents of methicillin-resistant Staphylococcus aureus with reduced glycopeptide-susceptibility is of grave concern. New agents are required to meet these threats and several classes of compounds are under development. This review focuses on agents that have been recently licensed or are presently in clinical development for the treatment of serious multidrug-resistant staphylococcal, enterococcal and pneumococcal infections, including methicillin-resistant S. aureus and vancomycin-resistant enterococci.     

New therapeutic agents for resistant Gram-positive infections

Gram-positive bacteria are an increasingly common cause of community acquired and nosocomial infections, and their resistance to antibiotics is increasing. The recent reports from several continents of methicillin-resistant Staphylococcus aureus with reduced glycopeptide-susceptibility is of grave concern. New agents are required to meet these threats and several classes of compounds are under development. This review focuses on agents that have been recently licensed or are presently in clinical development for the treatment of serious multidrug-resistant staphylococcal, enterococcal and pneumococcal infections, including methicillin-resistant S. aureus and vancomycin-resistant enterococci.     

Prevalence of resistance to MLS antibiotics in 20 European university hospitals participating in the European SENTRY surveillance programme. Sentry Participants Group.

Macrolide, lincosamide and streptogramin (MLS) antibiotics are chemically distinct inhibitors of bacterial protein synthesis. Resistance to MLS antibiotics may be constitutive or inducible. The purpose of this study is to update our understanding of the prevalence of different forms of MLS resistance in Europe. The analysis of 3653 clinical pneumococcal, staphylococcal and enterococcal isolates exhibited an average percentage of 21.3% and 6.2% intermediate and high-level penicillin-resistant Streptococcus pneumoniae, 21.8% methicillin-resistant Staphylococcus aureus and 11% vancomycin-resistant Enterococcus faecium. Geographical differences in erythromycin and clindamycin resistance in isolates of S. pneumoniae and S. aureus strongly reflect geographical variations in susceptibility to penicillin and methicillin, respectively. A very narrow range of MICs was obtained with quinupristin/dalfopristin, with no S. pneumoniae, S. aureus and E. faecium isolate having an MIC of > 4 mg/L, indicating a possible role of quinupristin/dalfopristin in the treatment of infections by multi-resistant Gram-positive bacteria.     

The Staphylococcus aureus "superbug"

There has been some debate about the disease-invoking potential of Staphylococcus aureus strains and whether invasive disease is associated with particularly virulent genotypes, or "superbugs." A study in this issue of the JCI describes the genotyping of a large collection of nonclinical, commensal S. aureus strains from healthy individuals in a Dutch population. Extensive study of their genetic relatedness by amplified restriction fragment typing and comparison with strains that are associated with different types of infections revealed that the S. aureus population is clonal and that some strains have enhanced virulence. This is discussed in the context of growing interest in the mechanisms of bacterial colonization, antibiotic resistance, and novel vaccines.     

Antimicrobial therapy of multidrug-resistant Streptococcus pneumoniae, vancomycin-resistant enterococci, and methicillin-resistant Staphylococcus aureus

Antibiotic resistance among pneumococci, enterococci, and staphylococci has become increasingly important in recent decades. Clinicians should be familiar with the nuances of antibiotic susceptibility testing and interpretation in selecting antibiotics for these infections. The clinical significance of penicillin-resistant Streptococcus pneumoniae, macrolide-resistant S pneumoniae, and multidrug-resistant S pneumoniae is discussed. The clinical spectrum and therapeutic approach to Enterococcus faecalis (i.e., vancomycin-sensitive enterococci) and E faecium (i.e., vancomycin-resistant enterococci) are discussed. Differences in therapeutic approach between methicillin-sensitive Staphylococcus aureus and methicillin-resistant S aureus (MRSA) infections are reviewed. Differences between in vitro susceptibility testing and in vivo effectiveness of antibiotics for hospital-acquired MRSA (HA-MRSA) are described. Finally, the clinical features of infection and therapy of HA-MRSA and community-acquired MRSA (CA-MRSA) infections are compared.