424株临床分离肠球菌属细菌的耐药性变异

目的探讨肠球菌属临床分离情况与耐药变迁，为指导临床合理用药，控制感染提供依据。方法对广东省东莞中山大学附属东华医院2007--2009年临床送检标本进行常规微生物培养、鉴定和药敏试验，并用WHONET5．4软件统计分析这3年间肠球菌临床分离株在各标本、科室中的分布与耐药性的变迁情况。结果2007--2009年临床分离出肠球菌属细菌424株，其中粪肠球菌338株，占79．7％，屎肠球菌75株，占17．7%，鸟肠球菌11株，占2．6％；肠球菌属在各标本中的分布以尿液为主，占50．2％，其次为伤口分泌物（14．4％）、血液（12．5％）。3年来肠球菌属的菌种和耐药均发生了较大变化，粪肠球菌所占比率每年保持在80％左右，屎肠球菌呈逐年上升趋势，从2007年的13．9%上升至2009年的20．9％，而鸟肠球菌则逐年下降，从4．7％降至0．6％。粪肠球菌对红霉素和四环素的耐药率最高，分别为79．4％～85．7％和84．1％～87．4%，屎肠球菌对氨苄西林、青霉素以及呋喃妥因的耐药率明显高于粪肠球菌，对红霉素、左氧氟沙星、青霉素的耐药率高达80％以上，对呋喃妥因、高浓度的庆大霉素、环丙沙星、四环素、氨苄西林等抗菌药物的耐药率也接近或超过50％。2007年发现1株屎肠球菌对万古霉素耐药。结论肠球菌属耐药性较为严重，不同菌种耐药性有所差异。临床抗感染治疗应以分离菌株的体外抗菌药物敏感性为依据，合理选用抗菌药物，以提高疗效。

Changing resistant pattern of 424 strains of Enterococcus during 2007--2009

Objective To study and analyze the changing resistant pattern of clinical strains of Enterococcus isolated from 2007 to 2009 in our hospital for appropriate use of antibiotics in clinical practice. Methods The strains were isolated and identified from clinical specimens in our hospital during 2007 and 2009. WHONET 5.4 software was used to analyze the data. Results A total of 424 strains of Enterococcus were collected, including E. faecalis （338, 79.7%） and E. faecium （75, 17.7%） and E. avium （11, 2. 6%）. The Enterococcus isolates were mainly from urine （50. 2%）, wound secretion （14. 4%）, and blood （12.5% ）. Large changes have taken place in the bacterial distribution and drug-resistance of isolated enterococci, and the drugresistance of strains of enterococci differed greatly during the last 3 years. The proportion of E. faecalis was about 80% during the 3 years. The proportion of E. faecium increased from 13.9% in 2007 to 20.9% in 2009. The proportion of E. avium decreased from 4.7 % in 2007 to 0.6 % in 2009. The Enterococcus isolates were highly resistant to erythromycin and tetracycline. About 79.4%-85.7% of the isolates were resistant to erythromycin and 84. 1%-87.4% resistant to tetracycline. E. faecium was more resistant to ampicillin, penicillin and nitrofurantoin than E. faecalis. More than 80% of the E. faecium isolates were resistant to high level erythromycin, levofloxacin and penicillin, more than 50% of these strains were resistant to high level nitrofurantoin, gentamycin, ciprofloxacin, tetracycline and ampieillin. A strain of vancomycin-resistant E. faeciurn was i- solated in 2007. Conclusions The antibiotic resistance is very serious in clinical isolates of Enterococcus. Antimicrobial therapy for such enterococcal infections should be based on the results of antimicrobial susceptibility testing.