457株肠球菌的分布及其耐药性分析

目的了解肠球菌在临床标本中的分布及对常用抗菌药物的耐药现状,特别是对耐万古霉素肠球菌的耐药分析。方法对临床标本中分离出的细菌进行系统检验,用西门子公司Microscan全自动细菌鉴定仪将细菌鉴定到种。并根据美国临床实验室标准化委员会(NCCLS)的标准,用美国Microscan全自动细菌鉴定仪的药敏分析系统固有的统计软件进行统计得出结果。结果本院6年内共分出肠球菌数为457株,其中粪肠球菌345株,屎肠球菌71株,其他为41株。主要分布在尿(中段尿)、前列腺液、生殖道分泌物、痰、血等标本中,其中从泌尿系感染患者尿液中分离的肠球菌占第一位(占27.6%)。抗菌药物方面,肠球菌对万古霉素、呋喃妥因、利奈唑烷的敏感性较高,但对临床常用抗菌药物显示高水平耐药,甚至屎肠球菌对首选药物青霉素耐药率近年来高达100%。同时,发现耐万古霉素的粪肠球菌和屎肠球菌各1例,这些都需要引起临床及检验人员的注意。结论肠球菌的感染分布已扩大化,且对临床常用抗菌药物出现高水平耐药,甚至出现了耐万古霉素的肠球菌(VRE),因此临床医师应关注临床常见肠球菌的耐药性,谨慎应用万古霉素,动态监测肠球菌的耐药状况,对指导临床治疗具有重要意义。

Objective To understand the clinical distribution of Enterococcus and the drug resistance to common antibiotics,especially for vancomycin-resistant enterococci drug resistance analysis.Methods Systematic inspection was carried out for the bacteria isolated from clinical specimens,Microscan walkaway automatic bacteria identification and drug sensitivity test equipment of DADE BETHRING company was used for identifying Enterococcus into specimen.Results were yielded by statistical software in Microscan walkaway automatic bacteria identification system,according to standard of NCCLS.Results 457 strains of enterococci have been isolated in the last 6 years,of which 345 is Enterococcus faecal and 71 for Enterococcus Faecom,and 41 strains for the others.Mainly distributed in the urine（medistream urine）,prostate,genital secretions,sputum,blood,the separation of enterococci from the urinary tract infection ranks first（27.6%）.In the respect of antibacterial drugs,enterococcus was highly sensitive to vancomycin,Furadantin and Linezolid,but to the common clinical drug showed a high level of resistance,even the rate of the preferred drug penicillin-resistant of Enterococcus Faecom was as high as 100%,meanwhile,vancomycin-resistant Enterococcus faecalis and Enterococcus Faecom was found for one instance each,Therefore clinical and laboratory must pay attention to.Conclusion The distribution of infection of enterococcus was broadened Therefore clinicians should pay attention to the drug resistance of common Enterococcus and applicate vancomycin carefully.Dynamic monitoring of drug resistance of enterococci has a great signif icance in guiding clinical treatment.