临床分离的肠球菌株耐药性变迁分析

Antibiotic-resistance Profile of Isolated Enterococci

目的 了解我院近 5年来肠球菌在临床标本中的分布特点及其耐药性变迁 ,更好地指导临床合理使用抗生素。方法 常规方法进行菌株分离 ,应用VITEK 32型全自动微生物分析仪进行菌株鉴定、药敏试验及庆大霉素和链霉素增效筛选试验 ,部分药敏采用纸片扩散法。结果 近 5年从各种临床标本中共分离到肠球菌 2 5 5株 ,其中痰液 4 2 6 %、尿液 34 2 %、脓液 11 2 %、胆汁 4 9%、其他标本 7 1% ;万古霉素和替考拉宁 5年中对肠球菌均保持最强的抗菌活性 ;氨苄西林、青霉素、呋喃妥因对肠球菌也保持较强抗菌活性 ,5年中耐药率均 <2 0 % ,耐药率上升最快的是环丙沙星和四环素 ,5年中分别上升了 4 3%和 33% ,高剂量庆大霉素和高剂量链霉素耐药率虽有上升 ,但近两年趋于稳定。结论 肠球菌在临床各标本中的检出率有逐年上升的趋势 ,氨苄西林、青霉素和呋喃妥因对肠球菌有较稳定的抗菌活性 ,万古霉素和替考拉宁对肠球菌有最强的抗菌活性 ,但临床已检出耐万古霉素肠球菌 ,值得重视。

OBJECTIVE To investigate the distribution character and antibiotic-resistance profile of entericocci and provide right use of antibiotics to treat the infection resulted from enterococci. METHODS Enterococci were isolated from clinical specimens by routine method. The identifications and most susceptibility tests were determined by VITEK-32 Automated Microbiology Analyzer. Some susceptibility tests were proceeded by disk diffusion. RESULTS In past 5 years, a total of 255 strains of enterococci were isolated from all kinds of clinical specimens. Isolates from sputum,urine,abscess,bile and others were 42.6%, 34.2%,11.2%,4.9%,and 7.1%, respectively.The strongest antibacterial activity to isolates was vancomycin and teicoplanin. Ampicillin, penicillin G and nitrofuran were keeping very strong antibacterial activity to isolates. Their resistant rates were less than 20% in past 5 years. Those of ciprofloxacin and tetracycline increased 43% and 33%. The resistant rates of high-dose gentamicin and high-dose streptomycin were keeping stable in recent 2 years. CONCLUSIONS Ampicillin,penicillin G and nitrofuran may be used to treat the infection resulted from enterococci. Vancomycin and teicoplanin still have very strong antibacterial activity to enterococci.But vancomycin-resistant enterococci have emerged.