2002年血液标本分离的革兰氏阳性球菌的耐药性

The resistance of Gram positive cocci isolated in 2002 from blood specimens

目的 评估血液标本分离的革兰氏阳性球菌的耐药性。方法 血液标本分离的革兰氏阳性球菌的药物敏感性试验采用纸片扩散法 ,用 WHONET5软件分析试验数据。不同地区耐苯唑西林的金黄色葡萄球菌 (MRSA)分离率的差异采用 χ2 检验。结果 (1)革兰氏阳性细菌导致的菌血症所占的比例为 5 1.1% ,其中革兰氏阳性球菌 (不包括厌氧球菌 )占革兰氏阳性菌的 86 .9% ;(2 )血液标本分离的 MRSA占分离的金黄色葡萄球菌的 39.6 % ,北京地区的分离率最高 ,并且近 5年来有逐渐增加的趋势。血液标本分离的耐苯唑西林的凝固酶阴性葡萄球菌 (MRCNS)占凝固酶阴性葡萄球菌的 74 .7%。凝固酶阴性葡萄球菌的耐药性高于金黄色葡萄球菌 ;(3)草绿色链球菌、β-溶血链球菌对红霉素、克林霉素的耐药率较高 ;肺炎链球菌中青霉素耐药株所占的比例小于 37.5 % ;万古霉素耐药的肠球菌的检出率为 4 .5 %。结论 血液标本中分离的革兰氏阳性球菌对常用抗生素的耐药率非常高 ,对临床经验治疗带来很大的困难 ,需要加强监测。

Objective To investigate the antimicrobial resistance of clinical isolates of Gram positive cocci isolated from blood specimens. Methods Disc diffusion test (KB method) was used to study the (antimicrobial) resistance, and WHONET 5 was applied for statistical analysis. χ~2-test was used for statistical comparison of the isolated rate of MRSA in different areas. Results The isolated rate of Gram positive bacteria was 51.1% from bacteremia patients. The isolated rate of Gram positive cocci among Gram positive bacteria was 86.9%. The frequency of MRSA among Staphylococcus aureus (isolates) was 39.6%, and the isolated rate of MRSA in Beijing was the highest and showed an increased trend in the past five years. The frequencies of methillicin-resistant coagluase-negative Staphylococci among coagluase-negative Staphylococci, penicillin-(resistant) Streptococcus pneumonia isolates as well as vancomycin-resistant (Entercocci) were 74.7%, 37.5% and 4.5%, respectively. The resistance rates of Streptococcus viridans and β-haemolytic Streptococci against erythromycin and clindamycin were high. Conclusions It is important to (survey) the antimicrobial resistance of Gram positive cocci isolated from blood specimen, and the clinical chemotherapy should be applied accordingly to the surveillance data. Vancomycin should be recommended as the first choice to treat the severe infections with Gram positive cocci.