系统性红斑狼疮患者革兰阳性球菌感染病原菌分布及耐药性分析

目的 了解系统性红斑狼疮(SLE)患者革兰阳性球菌感染病原菌的种类、分布及耐药状况,指导临床医师合理使用抗菌药物.方法 应用ATB Expression自动细菌鉴定系统对菌种进行鉴定,用K-B纸片扩散法对病原菌进行药物敏感性试验.结果 481例SLE患者并发革兰阳性球菌感染122例,感染率为25.4%,例次感染率54.5%;共分离出病原菌262株,主要为金黄色葡萄球菌、表皮葡萄球菌、溶血葡萄球菌、粪肠球菌、屎肠球菌;179株葡萄球菌属中检出耐甲氧西林葡萄球菌(MRS)124株,占69.3%;57株对红霉素耐药而克林霉素敏感的葡萄球菌属中,D试验阳性26株,占45.6%;替考拉宁和万古霉素对MRSA和MRCNS的抗菌活性高;粪肠球菌对青霉素、氨苄西林、呋喃妥因、替考拉宁和万古霉素的耐药率低;屎肠球菌仅对替考拉宁和万古霉素敏感;粪肠球菌及屎肠球菌对高浓度庆大霉素的耐药率为62.5%和74.2%;未检出耐替考拉宁及万古霉素肠球菌.结论 调查结果表明,SLE患者并发细菌感染的临床表现无特异性,对SLE患者并发革兰阳性球菌感染的治疗和抗菌药物的选用具有重要参考价值.

Distribution of Pathogens and Their Antibiotic Resistance in Systemic Lupus Erythematosus Patients with Gram-positive Cocci Infections

OBJECTIVE To study the distribution of pathogens and their antibiotic resistance in systemic lupus erythematosus (SLE) patients with Gram-positive cocci infections,for guiding the rational use of antibiotics therapy.METHODS The identification was analyzed by ATB Expression automatic microbiology analytical instrument system.The bacterial susceptibility test was done by Kirby-Bauer agar diffusion method.RESULTS Among 481 patients included,122 (25.4%) had bacterial infections,the case-times infection rate was 54.5%.A total of 262 strains of pathogen strains had been isolated.Among 262 isolates,Staphylococcus aureus,S.epider-midis,S.haemolyticus,Enterococcus faecalis,and E faecium were the main pathogens.Totally 124 MRS strains were isolated and accounted for 69.3%.Of the 57 strains resistant to erythromycin but susceptible to clindamycin,26 strains (45.6%) showed the positive D test results.MRSA and MRCNS were the most sensitive to teicoplanin and vancomycin.Penicillin,ampicillin,teicoplanin and vancomycin were the most active agents against E.faecalis.E.faecium was sensitive to teicoplanin and vancomycin.About 62.5% of E.faecalis and 74.2% of E.faecium isolates were resistant to high level gentamicin.All of the E.faecalis and E.faecium isolates were susceptible to vancomycin and teicoplanin.CONCLUSIONS The clinical features of SLE patients with bacterial infections are lack of specificity.The data will be useful for reasonably choosing antimicrobial agents in the treatment of SLE patients with Gram-positive cocci infections.