儿童患者中肠球菌属临床分离株耐药特征分析

Profile of antimicrobial resistance in the Enterococcus isolates from children

目的了解儿童患者临床分离肠球菌属的耐药特征,指导临床合理用药。方法测定11种抗菌药物对158株肠球菌的MIC,Nithocefin纸片法检测β内酰胺酶,数据用WHONET5.3软件分析处理。结果158株儿童临床分离肠球菌中,粪肠球菌、屎肠球菌、坚韧肠球菌、鸟肠球菌和海氏肠球菌分别占56.3%、39.9%、1.3%、1.3%和1.3%;屎肠球菌对氨苄西林、阿莫西林-克拉维酸和环丙沙星的耐药率分别为96.8%,95.2%和84.1%,粪肠球菌对上述3种抗菌药的耐药率分别为23.6%,18%和49.4%,屎肠球菌的耐药率明显高于粪肠球菌(P<0.001);粪肠球菌出现2株万古霉素MIC为8mg/L的耐药菌,粪肠球菌和屎肠球菌对替考拉宁全部敏感。儿童患者中多重耐药肠球菌属菌株占88.6%。结论儿童患者肠球菌属的耐药状况十分严重,尤其屎肠球菌对β内酰胺类、氨基糖苷类和氟喹诺酮类抗菌药耐药率很高。

Objective To study the antimicrobial resistance pattern of 158 enterococcal isolates in a Children＇s Hospital for rational use of antibiotics. Methods Agar dilution was used to determine MIC of 11 antibiotics against the enteroeoeeal isolates. Nitrocefin was used to test the production of β-laetamase. The data were analyzed with WHONET 5.3 software. Results A total of 158 enterococcal isolates were collected from children. E. faecalis, E. faecium, E. durans, E. avium and E. hirae accounted for 56.3%, 39.9%, 1.3%, 1.3% and 1.3%, respectively. The proportion of E. faecium resistant to ampieillin, amoxicillin-clavulanic acid and ciprofloxacin was 96. 8%, 95. 2% and 84. 1%, respectively, while only 23. 6%, 18% and 49.4% of E. faecalis isolates were resistant to these 3 antibiotics. The resistance rate of E. faecium was significantly higher than that of E. faecalis. The MIC of vancomycin was 8 mg/L for the 2 E. faecalis isolates. E. faecalis and E. faecium isolates were all susceptible to teicoplanin. Multiple-drug resistance was found in 88.6% of enteroeoceal isolates. Conclusions The situation of antimierobial resistance is serious in Enterococcus isolates from children. In particular, E. faecium isolates are highly resistant to beta lactams, aminoglycosides and fluoroquinolones.