革兰阳性球菌临床分布与耐药性分析

Clinical distribution and antimicrobial resistance of Gram-positive coccus

目的分析临床分离的革兰阳性球菌的感染情况和耐药特征，为临床用药提供依据。方法收集山西省眼科医院2009年3月至2011年5月我院患者眼部标本分离培养、药物敏感试验。结果共分离出革兰阳性球菌531株。其中金黄色葡萄球菌6株（1．13％），表皮葡萄球菌488株（91．90％），缓慢葡萄球菌18株（3．39％），科氏葡萄球菌科氏亚种3株（0．56％），哥伦比亚肠球菌9株（1．69％），链球菌属7株（1．32％）。耐苯唑西林葡萄球菌（MRS）检出344株，检出率为70．51％。葡萄球菌属对多数抗菌药耐药严重，但未发现对万古霉素、利奈唑胺、喹努普汀／达福普汀、替考拉宁耐药耐药的菌株。对488株表皮葡萄球菌进行耐药情况检测，耐药株数分别为：氨苄西林／舒巴坦342株（70．08％）；苯唑西林342株（70．08％）；复方新诺明351株（71．93％）；红霉素390株（79．92％），；环丙沙星270株（55．33％）；克林霉素396株（81．15％）；利福平39株（7．99％）；莫西沙星15株（3．07％）；哌拉西彬他唑巴坦342株（70．08％）；青霉素G487株（99．79％）；庆大霉素159株（32．58％）；四环素102株（20．90％）。结论耐苯唑西林葡萄球菌有很高发生率，大部分为凝固酶阴性的葡萄球菌，对大部分常用抗菌药耐药率很高。应加强院内感染控制，防止耐药菌株的产生。

Objective To approach drug-resistance status of clinically isolated Gram-positive cocci in Shanxi Eye Hospital and to provide the evidence for clinically reasonable use of antibiotics. Methods A total of 531 strains of Gram-positive cocci were isolated from all kinds of eye specimens from Mar 2009 to May 2011 in Shanxi Eye Hospital. Organisms were cultivated and identified according to National Clinical Laboratory Operation Rule. The drug sensitivity testing was performed by MIC methods. Results Among the 531 strains, the isolating rate of Staphylococcus epidermidis ranked the first（488 strains）. The detection rate of meticillin-resistant Staphyloccus epidermidis （MRSE）was 70.51% （344 strains）. The Gram-positive cocci were resistant to the commonly used antibiotics in different degrees except a 100% sensitivity to Vancomycin, Teicoplanin, Linezolid, and Quinupristin/ Dalfopristin. Conclusion We should strengthen the management of nosocomial infections to prevent the dissemination and epidemic of drug-resistant strains.