362株肠球菌对抗菌药物的耐药性研究

Resistance Analysis of 362 Enterococcus Strains to Antimicrobial Agents

目的:了解粪肠球菌、屎肠球菌及其它肠球菌对抗菌药物的敏感性,为临床提供治疗依据。方法:采用K-B法对362株自临床送检的血液、尿液及其他标本分离的肠球菌进行药敏试验。结果:362株肠球菌属中,粪肠球菌256株、屎肠球菌85株、其他肠球菌21株。粪肠球菌对氨苄西林、环丙沙星、青霉素G的耐药率分别为61.8%、48.7%、36.8%,低于屎肠球菌的90.5%、76.7%、82.3%;粪肠球菌、屎肠球菌对红霉素的耐药率分别达到86.3%和91.2%,对万古霉素的敏感性均>95%。高耐氨基糖苷类肠球菌(HLAR)的分离率为粪肠球菌42.7%、屎肠球菌71.0%,屎肠球菌HLAR的检出率高于粪肠球菌。通过高耐氨基糖苷类肠球菌与非HLAR肠球菌株的敏感性比较发现,肠球菌的非HLAR株的敏感性均高于HLAR株。结论:粪肠球菌、屎肠球菌对不同抗菌药物的敏感性差异较大,治疗时应根据耐药特点及菌种间的耐药性差异选择相应的药物和方案,目前万古霉素仍然是治疗肠球菌属感染的有效药物,但临床应慎用万古霉素,以免诱发耐药菌株的产生和流行。

Objective To investigate the susceptibility of Enterococcus faecalis （ E. faecatis ） , Enterococcus faecium （ E. faeciurn） and other Enterococcus spp so as to provide reference for clinical therapy. Methods The susceptibility of 362 Enterococcus strains isolated from blood, urine and other samples were tested with K-B method. Results All 362 strains of Enterococcus,including 256 strains of E. faecalis and 85 strains of E. faecium and 21 strains of other Enterococcus spp were isolated. The drug resistance rate of E. faecalis to ampicillin, ciprofloxacin, penicillin G were 61.8% ,48.7% ,36.8% , respectively, which were significantly lower than that of E. faecium （90.5 % ,76.7%, 82.3 % ）. The drug resistance rates of E. faecalis and E. faecium to erythromycin were high to 86.3% and 91.2%, and to vancomycin were both bigger than 95%. The separation rates of high-level aminoglycoside resistance（HLAR） from E. faecalis and E. faecium were 42.7% and 71.0% ,the detection rate of E. faecium was higher than that of E. faecalis. The drug susceptibility of non-HLAR strains was higher than that of HLAR strains. Conclusion The drug susceptibility of E. faecalis and E. faecium to different antimicrobial a- gents had great difference, the selection of antimicrobial agents in clinical therapy should based on the characteristic and difference of resistance. Vancomycin is the active drug for treatment at present, but its use should be careful in case of the emergence of resistance strains.