粪肠球菌和屎肠球菌临床分离株的耐药性检测及比较

Antimicrobial resistance testing and comparison of clinically isolated enterococcus faecalis and enterococcus faecium

目的比较粪肠球菌和屎肠球菌感染的临床特点及其耐药性,指导临床合理使用抗菌药物。方法采用琼脂稀释法检测112株粪肠球菌和118株屎肠球菌对13种抗菌药物的最小抑菌浓度(MIC)。结果粪肠球菌和屎肠球菌在泌尿系统的感染最为常见,分别占56.3%和67.0%,两者感染在性别分布上差异有统计学意义(P<0.01);粪肠球菌和屎肠球菌对青霉素、氨苄西林、氯霉素、环丙沙星、左氧氟沙星、红霉素、四环素以及高浓度庆大霉素和高浓度链霉素这9种抗菌药物的耐药率差异有统计学意义(P<0.01);未发现对万古霉素、替考拉宁和利奈唑胺耐药的菌株。结论屎肠球菌对临床常用抗菌药物的耐药率高于粪肠球菌,且多药耐药和高耐现象相当严重;在治疗时,应根据耐药特点及菌种间的耐药性差异来选择相应的治疗方案;目前万古霉素、替考拉宁和利奈唑胺仍然是治疗肠球菌感染的最好药物。

Objective To compare clinical features and drug resistance of E.faecalis and E.faecium to guide clinical rational use of antimicrobial agents.Methods The minimum inhibitory concentrations （MICs） of 13 kinds of antimicrobial agents against 112 isolates E.faecalis and 118 isolates E.faecium were detected by agar dilution method.Results The infection of E.faecalis and E.faecium in the urinary system were the most common,accounted for 56.3% and 67.0% respectively.The difference between E.faecalis and E.faecium in gender distribution was significant（P〈0.01）.The drug resistance of the two species to 9 antimicrobial agents including penicillin,ampicillin,chloramphenicol,ciprofloxacin,levofloxacin,erythromycin,tetracycline,high-level gentamicin and high concentrations of streptomycin were significantly（P〈0.01）.Not detected the strains which resistant vancomycin,teicoplanin or linezolid.Conclusion The antimicrobial resistance rate of E.faecium is higher than E.faecalis,and multi-drug resistance and high resistance are quite serious.Treatment shall be based on resistance characteristics and differences in drug resistance among bacteria to select the appropriate programs.Vancomycin,teicoplanin and linezolid are still the best medicine to treat enterococcal infections.