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。

Analysis of status of Enterococcal infections and changes of drug-resistance

Objective To study the status of the Enterococcal infections and Changes of drug-resistance.Methods According to CLSI recommendation,disk diffusion method was used to test the antimicrobial resistance of enterococci isolated from the patients of Sun Yat-sen Memorial Hospital during 2009~2011.The data was analyzed by WHONET5.3 and SPSS softwares.Results A total of 1016 strains of Enterococci were isolated from a variety of clinical specimens,including 587 strains of Enterococcus faecalis（57.78%） and 370 strains of Enterococcus faecium（36.42%）.The majority of strains were isolated from urine（21.26%）,sputum（17.42%）,and body fluid and bile（17.22%）.About 0%,7.5 % and 7.5% of E.faecalis were resistant to Ampicillin/Sulbatan,ampicillin and Imipenem,and Forty percent（40%） of E.faecalis isolates were resistant to gentamicin（high level）.E.faecium strains were more resistant to most of the antibiotics tested than E.faecalis.More than 90% E.faecium strains were resistant to Ampicillin/sulbatan;and nearly 70% resistant to gentamicin（high level）,but only 0.96% resistant to Quinupristin/Dalfopristin.Strains of Enterococci were highly susceptible to linezolid,vancomycin and teicoplanin（The resistant rates were≤5%）.1 and 8 strains of Enterococcus faecium were found resistant to Vancomycin respectively in 2010 and 2011.6 and 4 strains of E.faecalis were found resistant to linezolid respectively in 2010 and 2011.5 strains of Enterococcus faecium were found resistant to teicoplanin in 2011.Conclusion Vancomycin,teicoplanin and linezolid remains the most potent antibacterial agents against Enterococci.It is very important to monitor the drug resistance of Enterococci in spite of the increasing prevalence of VRE,especially the emergence of linezolid resistant strains.