重型肝炎患者肠球菌感染及体外药敏监测

Status and drug resistance surveillance of enterococcus infection in patients with severe hepatitis

目的分析重型肝炎患者肠球菌感染的现状及体外药敏特点。方法采集重型肝炎患者的各类标本做细菌培养,并测定对常用抗菌药物的敏感性。结果所有纳入研究范围的重型肝炎患者共检出肠球菌112株,其中粪肠球菌 89株,比例最高,占79．5％,屎肠球菌16株,占14．3％,居第二位。腹水中肠球菌检出率最高,达到57．1％。检出高耐庆大霉素肠球菌58株,占51．8％,耐氨苄西林肠球菌19株,占17．0％,多重耐药(庆大霉素高水平耐药合并氨苄西林耐药)肠球菌7株,占6．3％。肠球菌对万古霉素和替考拉宁的敏感率最高,分别达到96．4％和100％。未检出耐万古霉素肠球菌,但检出万古霉素中介肠球菌4株,占3．6％。结论肠球菌是重型肝炎患者感染的重要致病菌,尤以粪肠球菌为主。并发肠球菌感染时,应高度重视细菌培养和药敏实验,为合理抗菌治疗提供依据。万古霉素和替考拉宁是治疗肠球菌感染的首选药物。

Objective To analyze the infection status and the drug resistance of enterococci in patients with severe hepatitis to guide future treatment. Methods All bacteria from infected patients with severe hepatitis were cultured with BacT/ Alert120 automation instrument （Aksu） and identified with Vitek-AMSt0 （Biomerieux）. Drug sensitivities of the isolated enterococci were tested with 11 antibacterial agents. Results Among the 112 isolated enterococci, Enterococcus faecalis was the most preponderant bacterium, and the second was E. faecium. Their isolation rates were 79.5% and 14.3%, respectively. 57.1% of all the enterococci were found in the ascetic fluid of patients with severe hepatitis. Fifty-eight （51.8%） isolated enterococci were found to be high level aminoglycoside resistant （HLAR）, 19 （17.0%） enterococci were ampicillin-resistant enteroeoecus （ARE） and 7 （6.3%） were both HLAR and ARE. The susceptive rates of the enteroeoeci to vancomycin and teicoplanin were very high, namely 96.4% and 100%, respectively. No vancomycin or teicoplanin resistant enteroeoeci were found, but 4 enteroeoeci were mildly sensitive to vancomycin. Condusion Enteroeoecus faecalis is the most prevalent species isolated in severe hepatitis patients infected with enteroeoecal infection. From our study, vancomycin and teicoplanin are the drugs of first choice to treat those infections.