肠球菌临床感染情况和药物敏感性分析及耐万古霉素肠球菌耐药基因研究

目的分析肠球菌的临床分离情况,研究肠球菌抗菌药物敏感性和耐万古霉素肠球菌（VRE）耐药基因。方法采用VITEK COMPACT分析仪进行菌种鉴定和药敏测定;采用WHONET 5.5进行数据分析;采用PCR、基因测序及序列在线比对检测VRE耐药基因。结果共分离167株菌,屎肠球菌113株,粪肠球菌47株;标本类型前三位分别为尿液（34.1%）、血液（16.8%）和腹水（15.6%）;ICU分离率在临床科室中居首。屎肠球菌对青霉素G、氨苄西林、红霉素、环丙沙星、左氧氟沙星的耐药率高达90%以上,且明显高于粪肠球菌（P〈0.05）。检出11株VRE,携带vanA耐药基因。未发现利奈唑胺耐药株。结论肠球菌总体耐药形势严峻,屎肠球菌的分离率和耐药率高于粪肠球菌,应控制多重耐药株尤其VRE的传播。

Clinical distribution,antimicrobial susceptibility and vancomycin resistance gene of Enterococcus

Objective To analyze the clinical distribution and antimicrobial susceptibility of enterococci,and research the resistance gene of vancomycin-resistant enterococci.Methods Bacteria identification and antimicrobial susceptibility test were carried by VITEK COMPACT system.Data were analyzed by WHONET5.5software.Resistance gene of VRE was detected by PCR,gene sequencing and BLAST online.Results 167strains of Enterococci had been isolated,including 113 Enterococcus faeciums and 47 Enterococcus faecalis.The top three specimens were urine（34.1%）,blood（16.8%）and ascites（15.6%）.The top clinic departments from which the strains isolated was ICU（24.6%）.Drug resistance of Enterococcus faeciums was harder than which of Enterococcus faecalis.The percentage of Enterococcus faeciums resistant to penicillin-G,ampicillin,erythromycin,ciprofloxacin and levofloxacin was more than 90%,and was higher than which of Enterococcus faecalis significantly（P〈0.05）.There were 11stains of Enterococci resistant to vancomycin,being confirmed carrying the vanA resistance gene.All the strains were susceptible to linezolid.Conclusion The antimicrobial resistance is serious in Enterococci,the isolating rate and resistance rate of Enterococcus faeciums are higher than which of Enterococcus faecalis.Clinicians and laboratory staff should pay attention to prevent the dissemination of resistance.