2007年中国CHINET肠球菌属耐药性监测

CHINET 2007 surveillance of antibiotic resistance in Enterococcus in China

目的了解中国不同地区临床分离肠球菌属对各类抗菌药物的耐药性。方法国内主要地区12所教学医院(10所综合性医院,2所儿童医院)按统一方案、采用统一的材料、方法(KB法)和判断标准(CLSI 2007年版)进行肠球菌属的耐药性监测。结果共分离到2634株非重复肠球菌,最常见菌种为粪肠球菌1281株(48.6%)、屎肠球菌1017株(38.6%)、耐久肠球菌94株(3.6%)、鸟肠球菌50株(1.9%)、鹑鸡肠球菌50株(1.9%)。粪肠球菌对呋喃妥因、磷霉素的耐药率均低于10%,对氨苄西林耐药率为12.9%,对高浓度庆大霉素耐药率接近50%;屎肠球菌耐药性明显高于粪肠球菌,对氨苄西林耐药率接近90%,对高浓度庆大霉素耐药率>70%,但对氯霉素耐药率仅为6.1%。全年共检出万古霉素耐药粪肠球菌6株和屎肠球菌21株,经PCR证实均系VanA型耐药,未发现利奈唑胺耐药株。结论肠球菌属耐药性较为严重,VRE的发生率有增加趋势,应引起临床和实验室高度重视。

Objective To investigate the antimicrobial resistance in Enterococcus species isolated from hospitals in several regions of China during year of 2007. Methods Ten general hospitals and two children＇s hospitals were involved in this program. Antimicrobial susceptibility testing was carried out by means of Kirby-Bauer （KB） according to the unified protocol. The data were analyzed by WHONET 5.4 software according to CLSI 2007 breakpoint. Results A total of 2 634 nonduplicate Enterococcus isolates were collected, including 1 281 E. faecalis （48.6%）, 1 017 E. faecium （38. 6%）, 94 E. durans （3.6%）, 50 E. avium （1.9%） and 50 E. gallinarum （1.9 % ）. The resistant rates of E. faecalis to nitrofurantoin and fosfomycin were lower than 10%. The resistant rate to ampicillin was 12. 9%. The resistant rate of E. faecium strains to most drugs tested was higher than that of E. faecalis. Nearly 90% E. faecium strains was resistant to ampicillin, but only 6. 1% to chloramphenicol. More than 70% of E. faecium and nearly 50 % of E. faecalis isolates were resistant to gentamicin （high level）. A total of 6 E. faecalis and 21 E. faecium strains were found resistant to vancomycin. Vancomycin resistance gene vanA was detected in all VRE strains. Linezolid-resistant strain was not found. Conclusions Enterococcus isolates exhibit multidrug resistance. The prevalence of VRE is increasing in some hospitals, which should be paid serious attention to in clinical and laboratory practice.