2356株革兰阳性球菌的分布与耐药性分析

Distribution and drug resistance of 2356 strains of gram-positive cocci

目的了解医院近3年革兰阳性球菌分布和耐药性变迁,指导临床合理使用抗菌药物。方法 2007年1月-2009年12月从医院临床标本分离出革兰阳性球菌,对其进行细菌分布和耐药性回顾性分析。结果 3年共分离革兰阳性球菌2356株,凝固酶阴性葡萄球菌居首位,占34.0%;标本来源以痰、血、分泌物标本最多见;分离出472株耐甲氧西林金黄色葡萄球菌(MRSA),MRSA中未发现耐利奈唑胺和万古霉素菌株,MRSA对氯霉素和喹奴普汀/达福普汀的耐药率较低,分别为12.1%和0.6%;对利福平的耐药率逐年增加,从11.5%增加至73.6%;粪肠球菌对青霉素G、氨苄西林的耐药率分别为17.7%和5.2%,显著低于屎肠球菌;未发现耐利奈唑胺肠球菌和耐万古霉素肠球菌(VRE)。结论革兰阳性球菌引起的耐药现象严重,加强耐药性监测,合理使用抗菌药物非常重要。

OBJECTIVE To investigate the distribution and drug resistance of Gram-positive cocci isolated in the past 3 years,and to provide an optimal antimicrobial therapy.METHODS A retrospective analysis was made to investigate drug resistance of Gram-positive cocci isolated during the period of Jan 2007 to Dec 2009.RESULTS A total of 2356 Gram-positive cocci were isolated from clinical samples,the predominant pathogen was coagulase-negative Staphylococcus.The Gram-positive cocci were mainly isolated from the specimens of sputum,blood and secretion.472 strains of meticillin-resistant Staphylococcus aureus（MRSA） were detected,none of which was resistant to linezolid and vancomycin.The resistance rates to chloramphenicol and quinupristin/dalfopristin were 12.1% and 0.6%,respectively,and to rifampin was increasing greatly from 11.5% to 73.6% in the strains of MRSA.The resistance rates of Enterococcus faecalis to penicillin G and ampicillin were 17.7% and 5.2%,respectively,which were significantly lower than those of E.faecium.None of linezolid-resistant Enterococcus and vancomycin-resistant Enterococcus isolates was detected.CONCLUSION The drug resistance of Gram-positive cocci is serious.It is very important to enhance the drug resistance monitoring and rational application of antibiotics.