729株肠球菌的耐药分析

目的：分析肠球菌在各类感染标本中分布与常用药物敏感性情况,为临床治疗提供参考。方法：收集华中科技大学附属同济医院2012年1~12月各科临床标本分离出的729株肠球菌属,采用法国梅里埃生物鉴定系统进行菌种鉴定,并采用扩散法进行耐药监测。结果：检出的729株肠球菌属中,粪肠球菌219株（30.2%）,屎肠球菌257株（35.3%）,未鉴定到种220株（30%）,其他肠球菌共33株（5%）。临床标本主要来自尿液、排泄物和分泌物,尿液278株（38.1%）、引流液94株（12.9%）和伤口分泌物75株（10.3%）。屎肠球菌对青霉素、氨苄西林、高浓度庆大霉素、环丙沙星、左氧氟沙星、红霉素和呋喃妥因的耐药性明显高于粪肠球菌,未检出耐利奈唑胺屎肠球菌株。肠球菌对万古霉素、替考拉宁和利奈唑胺的敏感性较高,分别为96.4%、97.9%和99.9%。结论：肠球菌属感染以粪肠球菌和屎肠球菌为主,以泌尿系统感染最为多见。不同种类肠球菌耐药性差别较大,且呈多重耐药。临床用药应结合药敏结果,合理选用抗菌药。

Analysis of Bacteria Resistance and Drug Selection of 729 Strains of Enterococcus

Objective：To analyze the distribution and drug resistance of enterococcus in various infection samples to provide references for the clinical treatment.Methods：729 strains of clinically isolated enterococcus genus were collected from Tongji Hospital in Hubei Province from January 2012 to December 2012.An antimicrobial susceptibility teat was performed with Kirby-Bauer disc diffusion method and their results were analyzed according to CLSI 2011 guideline Results： 729 strains of enterococcus were isolated.219 of them（30.2%） were enterococcus faecalis,257（35.3%） were enterococcus faecium,220（30%） were enterococcus sp,and the other enterococcus accounted for 33（5%）.These strains mainly coming from urine,drainage and secretion were as follows;278 strains（38.1%） from urine,94 strains（12.9%） from drainage, and 75 strains（10.3） from secretion.Enterococcus faecium had a higher resistance rate than enterococcus faecalis to penicillin,ampicillin,high concentration of gentamycin,ciprofloxacin,levofloxacin,erythromycin and furadantin.No linezolid-resistant enterococcus faecium was found.Vancomycin,teicoplanin and linezolid had their higher sensitivity to enterococcus,which accounted for 96.4%,97.9%and 99.9%,respectively.Conclusion：The enterococcus faecalis and enterococcus faecium were the most common cause of nosocomial infection pathogen.The enterococcus was mostly found in the urinary tract infection.The antimicrobial resistance of enterococcus varied greatly according to different types,and most of them were multidrug resistance.Enterococcus isolated from clinical samples should be identified to species as far as possible,so the treatment of enterococcus bacteria＇ s infection could be based on the drug susceptibility test results and the antibiotics could be more reasonably used.