临床常见革兰阳性球菌的分布与耐药性分析

Analysis on clinical distribution and antimicrobial resistance of common gram-positive cocci

目的了解常见革兰阳性球菌的临床分布特点及耐药状况。方法对哈尔滨医科大学附属第一医院2001年1月至2008年12月门诊或住院患者送检后痰液或气管抽吸液、尿液等标本采用API细菌鉴定系统鉴定到种,K-B法进行药敏感试验。结果 8年间共分离出25052株细菌,其中革兰阳性球菌7907株(31.6%);居前3位的为金黄色葡萄球菌3549株(44.9%)、肠球菌1760株(22.3%)、凝固酶阴性葡萄球菌1558株(19.7%)。MRSA的发生率从2001年的59.6%上升到2008年的76.3%;MRSCoN的发生率由64.2%上升到77.0%。耐甲氧西林金黄色葡萄球菌(MRSA)对庆大霉素、克林霉素、红霉素和左氧氟沙星等抗菌药物的耐药率均>90%,对复方新诺明、氯霉素的耐药率均<20%;而MSSA对庆大霉素、左氧氟沙星、复方新诺明和氯霉素的耐药率均<20%,并对除青霉素外的β-内酰胺类抗菌药物耐药率均0。MRSCoN对各类抗菌药物的耐药率较MRSA低,但对复方新诺明的耐药率(71.2%)却较MRSA(21.2%)为高;未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌;屎肠球菌和其他肠球菌中分别有2.1%和4.4%对万古霉素耐药,未发现对替考拉宁和利奈唑胺耐药的肠球菌。结论革兰阳性球菌耐药呈明显上升趋势,MRS检出率高。万古霉素、替考拉宁和利奈唑胺为临床治疗多重耐药的革兰阳性球菌引起的难治性感染的首选药物。

Objective To investigate the clinical distribution and antimicrobial resistance of common grampositive cocci in author＇s hospital. Methods Identification of these bacteria were done with API analysis system, disc diffusion tests were employed to study the antimicrobial resistance. Results A total of 25 052 clinical isolates were collected in 8 years, of gram-positive cocci accounted for 7907 （31.9% ）. Stapilylococcus anreus （3549 strains, 44. 9% ）, enterococcus （ 1760 strains, 22. 3% ） and coagulase-negative staphylococcus （ 1558 strains, 19.7% ）were the most common isolates. The prevalence of MRSA increased from 59. 6% in 2001 to 76. 3% in 2008, and MRSCoN increased from 64. 2% to 77. 0%. The resistant rate of MRSA to gentamicin, clindamycin, erythromycin and levofloxacin were over 90%, to trimethoprim/sulfamethoxazole and chloramphenicol were less than 20%. The resistant rate of MSSA to gentamicin, levofloxacin, trimethoprim/sulfamethoxazole and chloram- phenicol were low 20%, and to beta-lactamase antibacterial agents except penicillin were 0. The resistant rates of MRSCoN to all antimicrobial agents were lower than MRSA, but to trimethoprim/sulfamethoxazole（71.2% ）was higher than MRSA（21.2% ）. No staphylococcus strains were resistant to vancomycin , teicoplanin and linezolid. 2. 1% enterococcus feacium and 4. 4% other enterococcus were resistant to vancomycin. No strains of enterococcus were found resistant to teicoplanin and linezolid. Conclusion The resistant rate of gram-positive cocci were increasing obviously, the prevalence of MRS was high. Vancomycin ,teicoplanin and linezolid were the most active agents against severe infection induced by multidrug-resistant gram-positive cocci.