武汉市和周边地区临床分离肠球菌的耐药性比较

A Comparison of Antimicrobial Resistance of Clinical Isolates of Enterococci from Wuhan City and Neighbor Areas

目的 了解不同地区肠球菌的耐药性 ,为临床治疗提供依据。方法 采集武汉市 8所医院及周边地区 6所医院临床分离的不重复的肠球菌 ,菌种鉴定用微生物检测常规方法或API、ATB系统 ,药敏试验用K B法 ,资料用WHONET 5软件和 χ2 检验进行统计学分析。结果 武汉市临床分离的肠球菌中粪肠球菌、屎肠球菌分别占 70 1%、2 0 8% ,周边地区为 80 8%、 13 9% ;武汉市标本来源构成前 5位的为尿液 37 8%、分泌物 15 0 %、引流液 8 2 %、痰液 7 3%、伤口分泌物 6 8% ,周边地区为尿液 32 8%、生殖道分泌物 19 8%、分泌物 19 4 %、痰液 11 8%、伤口分泌物 4 6 % ;武汉市和周边地区粪肠球菌对万古霉素、呋喃妥因、氨苄西林、高浓度庆大霉素的耐药率分别为2 1%、 7 2 %、 2 2 6 %、 4 1 4 %和 1 8%、 6 9%、 2 3 2 %、 4 0 3% ;武汉市和周边地区屎肠球菌对以上 4种抗生素的耐药率分别为 1 3%、 18 2 %、 76 3%、 73 0 %和 1 9%、 2 1 3%、 6 4 6 %、 6 2 0 %。结论 武汉市临床分离的肠球菌耐药率比周边地区高 ,各地区应动态监测并及时公示肠球菌感染和耐药性资料 ,以指导临床用药。

Objective To study the enterococcal resistance from different areas. Methods Enterococci were identified by usual method or API, ATB system. Drug-rensitivity was tested by K-B method. The data were analyzed by WHONET-5 statistic software and χ2-test. Results Enterococcus faecalis isolates and E. faecium isolates accounted for 70.1 % and 20.8 % of the enterococcus isolates in Wuhan city and 80.8 % and 13.9 % in neighbor areas respectively. The enterococcus isolates from urine, secretion, drainage, sputum and wound accounted for 37.8 %, 15.0 %, 8.2 %, 7.3 % and 6.8 % in Wuhan city and in neighbor areas from urine, genital, secretion, sputum and wound accounted for 32.8 %, 19.8 %, 19.4%, 11.8 % and 4.6 %, respectively. The resistance rate of E. faecalis to vancomycin, nitrofurantoin, ampicillin, and high-level gentamicin was 2.1 %, 7.2 %, 22.6 %, and 41.4 % in Wuhan city, and 1.8 %, 6.9 %, 23.2 %, and 40.3 % in neighbor areas, respectively. The resistance rate of E. faecium to such four antibiotics was 1.3 %, 18.2 %, 76.3 % and 73.0 % in Wuhan city, and 1.9 %, 21.3 %, 64.6 %, and 62.0 % in neighbor areas, respectively. Conclusion The resistance rate of clinical isolates of enterococci in Wuhan city was significantly higher than in neighbor areas. The active surveillance and showing of bacterial drug-resistance should be taken in different areas.