医院感染革兰阳性球菌耐药性分析

Analysis on drug-resistance of gram-positive cocci in nosocomial infection

目的了解医院感染革兰阳性(G+)球菌分布及耐药特点,为临床治疗提供依据。方法对某院2006年临床送检的8 719份标本,常规培养、分离细菌并采用VITEK-2和API系统鉴定;纸片扩散法和肉汤稀释法对细菌进行药敏试验;WHONET5.4和SPSS11.5统计软件对数据进行统计分析。结果共分离细菌3 584株(41.11%),其中G+菌777株(21.68%),主要为凝固酶阴性葡萄球菌(CNS)259株,金黄色葡萄球菌(SA)234株,肠球菌属(ENT)156株。其中分离耐甲氧西林SA(MRSA)123株(占SA52.56%),耐甲氧西林CNS(MRCNS)214株(占CNS82.63%),粪肠球菌41株(占ENT26.28%),屎肠球菌107株(占ENT68.59%)。未发现对万古霉素和替考拉宁耐药的葡萄球菌属和粪肠球菌,发现1株对替考拉宁和万古霉素同时耐药和3株对万古霉素中介耐药的屎肠球菌;屎肠球菌对大多数抗菌药物的耐药率高于粪肠球菌(P<0.01);肺炎链球菌对青霉素的耐药率为64.28%。结论此次分离的G+菌以球菌为主,其中的葡萄球菌属以MRSA和MRCNS为主;分离到对万古霉素和替考拉宁耐药的屎肠球菌,以及对青霉素耐药的肺炎链球菌;屎肠球菌耐药性高于粪肠球菌。

Objective To investigate the distribution and drug-resistance of gram-positive cocci in nosocomial infection, so as to provide guidance for clinical treatment. Methods Bacteria isolated routinely from 8 719 clinical samples in a hospital in 2006 were identified by VITEK-2 and API System; antimicrobial susceptibility tests of bacteria were performed with disc agar diffusion and broth dilution methods; data were analysed with HWONET5.4 and SPSS11.5 software. Results 3 584 strains （41.11%） were isolated, 777 （21.68%）were gram-positive cocci, including 259 strains of coagulase negative staphylococci, 234 strains of Staphylococcus aureus, 156 strains of Enterococci spp. Among these gram -positive cocci, methicillin-resistant Staphylococcus aureus （MRSA） were 123 strains （accounting for 52. 56% of Staphylococcus aureus ） , methicillin-resistant coagulase negative Staphylococci （ MRCNS） were 214 strains（accounting for 82. 63 % of coagulase negative Staphylococci）, Enterococci faecalis were 41 strains （accounting for 26. 28% of Enterococci spp. ）, 107 strains were Enterococcus faecium （accounting for 68. 59% of Enterococci spp）. Vancomycin-resistant and teicoplanin-resistant Staphylococcus spp. and Enterococcus faecalis were not found, 1 strain of Enterococcus faecium was resistant to both teicoplanin and vancomycin, 3 strains of Enterococcus faecium were moderately resistant to vancomycin; antimicrobial resistant rates of Enterococcus faecium were higher than that of Enterococci faecali,s（P〈0. 01） ; the resistant rate of Streptococcus pneumonia to penicillin was 64. 28%. Conclusion The main isolated bacteria were gram-positive cocci, the majority of Staphylococci spp. were MRSA and MRCNS, vancomycin-resistant and teicoplanin-resistant Enterococcus faecium and penicillin-resistant Streptococcus pneumonia were isolated; the resistant rate of Enterococcus faecium were higher than that of Enterococcus faecalis.