临床分离肠球菌的分布特点及耐药性变迁

Clinical distribution and changes of antibiotic resistance in Enterococci from 2002 to 2006

目的分析临床分离肠球菌的分布特点及耐药性变迁,为临床合理应用抗生素提供依据。方法从中国医科大学附属盛京医院门诊和住院病人采集血液、尿液、手术切口分泌物、腹腔引流液等标本,应用法国生物梅里埃API细菌鉴定系统进行细菌的分离和种属鉴定,用K-B纸片琼脂扩散方法对不同肠球菌做药物敏感试验。结果肠球菌属的数量占全部分离到细菌种类的第6位。其中屎肠球菌的构成比,2002年为30.9%,2006年上升到71.6%,超过粪肠球菌的比例。肠球菌主要分布于ICU、普通外科、呼吸内科、肾内科、干诊、感染科和新生儿科病房。粪肠球菌对青霉素、氨苄西林和呋喃妥因的耐药率分别从2002年的53.6%、38.5%和30.4%下降到2006年的4.5%、0和4.5%,屎肠球菌对氯霉素的耐药率从2002年的37.1%下降到2006年的14.3%,两种菌对万古霉素和替考拉宁的敏感性均高,但临床出现耐万古霉素和耐替考拉宁的肠球菌。结论中国医科大学附属盛京医院临床肠球菌出现新的分布特点,屎肠球菌比例有增加趋势。调查肠球菌尤其是屎肠球菌感染的危险因素和采取相应的防治措施是当前研究的重要课题。

Objective To investigate the clinical distribution characteristics and the changes of antibiotic resistance of Enterococci and provide reference for clinical treatment. Methods All the clinical samples of Enterococci were identified with Strep strips of API system. Drug sensitivity tests were performed by K-B. Results The proportion of Enterococci lied in the sixth position in all the isolated clinical pathogens. The proportion of Enterocoecus faecium（EFM） ,which accounted for 30.9% to 71.6% from 2002 to 2006,was higher than that of Enterococcusfaecalis（EFA） along the time,and was different from the results of other researches. Enterococcus samples mainly came from ICU, general surgery ward, respira- tory ward, renal ward, old patients＇ward,infection disease ward, and neonatal ward. The resistant rate of EFA to penicillin, ampicillin and nitrofurantoin decreased from 53.6% ,38.5% and 30.4% in 2002 to 4.5% ,0 and 4.5% in 2006 respectively. The resistant rate of EFM to chloromycetin decreased from 37.1% in 2002 to 14.3% in 2006. The two Enterococci were highly sensitive to vancomycin and teicoplanin, but resistant Enterococci also occurred clinically. Conclusions The new distribution of Enterococcus strains occurred. Risk factors of Entercocci, especially EFA and EFM, should be investigated. The clinical application of antibiotics should follow the guidance of drug sentivity test.