儿童肠球菌感染及耐药性分析

Analysis of enterococcal infection and antimicrobial resistance in children

目的 :了解儿童肠球菌的感染及耐药性 ,为临床治疗提供依据。方法 :采集湖北省 15家三级甲等医院 2 0 0 0～ 2 0 0 3年儿科临床分离的不重复的肠球菌 ,按照美国NCCLS推荐的方法和判断标准 ,用纸片扩散法进行药敏试验 ,资料用WHONET5专用软件进行统计分析。结果 :儿科临床分离出肠球菌 3 2 8株 ,粪肠球菌、屎肠球菌、铅黄肠球菌分别占 5 7 3 %、2 8 1%、6 1% ;标本来源依次为尿液 46 3 % ,血液 2 0 7% ,分泌物 11 0 % ,粪便 7 3 % ,痰 6 1% ;肠球菌对万古霉素、替考拉宁、呋喃妥因、氨苄西林和高浓度庆大霉素的耐药率分别为 1 3 %、4 7%、2 6%、5 3 2 %、5 0 7% ;屎肠球菌除对万古霉素、替考拉宁敏感外 ,对其他常用抗菌药的耐药率均比粪肠球菌高 ;耐氨苄西林和氨基糖甙类高水平耐药肠球菌的分离率分别为 5 1 2 %和 2 9 3 % ,两者对万古霉素、替考拉宁、呋喃妥因、左旋氧氟沙星的敏感性较好。结论 :儿科肠球菌感染以泌尿和血液系统感染为主 ,菌株主要为粪肠球菌和屎肠球菌 ,它们对常用抗生素均产生了程度不同的耐药性 ,对万古霉素和替考拉宁的耐药率最低。

Objective:To study the infection and antimicrobial resistance of enterococci in children. Methods:According to NCCLS recommendation, disk diffusion method was used to test the antimicrobial resistance of enterococcal isolates from 15 grade 3A hospitals in wubei province. The data were analyzed by WHONET5 statistic software. Results:328 enterococcal isolates were detected in pediatrics; E. faecalis, E. faeium and E. casseliflavus accounted for 57.3%,28.1% and 6.1%, respectively. The enterococcal isolates from urine,blood,secretion,feces and sputum accounted for 46.3%,20.7%,11.0%,7.3%and 6.1%; The resistant rate of enterococci to vancomycin,teicoplanin,nitrofurantoin、ampicillin and high-level gentamicin were 1.3%,4.7%,26%,53.2% and 50.7%; Besides susceptible to vancomycin and teicoplanin, the resistant rate of E. facium to other antimicrobial agents was significantly higher than E. faecalis. The isolated rate of ARE and HLAR were 51.2% and 29.3.%, Both of them were susceptible well to vancomycin,teicoplanin,nitrofurantoin and levofloxacin. Conclusion:Enterococcal infections in pediatrics were mainly urinary tract infections and blood infections. The main enterococcal isolates were E. faecalis and E. facium. Both of them were resistant to usual antimicrobial agents in different degree and show the least resistance to vancomycin and teicoplanin.