重症监护室革兰阳性球菌分布及耐药性分析

The distribution and drug-resistance of Gram-positive cocci in intensive care unit(ICU)

目的了解重症监护室（ICU）革兰阳性（G＋）球菌临床感染情况和耐药现状,以指导临床用药。方法回顾性分析2011年1月~2011年12月深圳市人民医院重症监护室分离的94株G＋球菌的感染情况及耐药性。结果 94株中葡萄球菌属54株,分离株数最高为溶血葡萄球菌（21.28%）,其次为金黄色葡萄球菌（13.83%）;肠球菌属39株,分离株数最高为屎肠球菌（26.59%）,其次为粪肠球菌（11.70%）。标本来源以引流液标本分离率最高,其次为血标本,分离率分别为15.12%、3.45%;其中溶血葡萄球菌主要来源于血（40%）,金黄色葡萄球菌主要来源于痰（83.33%）,屎肠球菌（60%）主要来源于腹腔引流液。葡萄球菌和肠球菌属耐药现象严重,其中耐甲氧西林金黄色葡萄球菌（MRSA）、耐甲氧西林表皮葡萄球菌（MRSE）、耐甲氧西林溶血葡萄球菌（MRSH）分离率分别为53.85%、83.33%、100%,发现耐替考拉宁MRSH1株,未发现耐万古霉素及耐利奈唑胺葡萄球菌;肠球菌属中,发现耐利奈唑胺粪肠球菌一株,耐万古霉素海氏肠球菌一株,余肠球菌未发现耐万古霉素及利奈唑胺的菌株。结论 ICU分离的革兰阳性球菌以耐甲氧西林葡萄球菌为主,其次为肠球菌,标本来源以引流液标本分离率最高,存在多重耐药现象,对替考拉宁、万古霉素和利奈唑胺的敏感率最高,可作为治疗的选择,但临床已发现耐药菌株,应加强监测。

[Objective ] To review infective condition and drug-resistance of Gram-positive cocci in intensive care unit （ICU）, so as to guide the medicines application. [Methods] Review the cultural condition and drug-resistance of ninety-four Gram-positive cocci from Jan, 2011 to Dee, 2011, in Shenzhen People＇s Hospital. [Results] Among ninety-four cocci, fifty-four were staphylococcus, of which staphylococcus haemolyticus was at the most （21.28%）, and staphylococcus aureus was following （13.83%）. Thirty-nine were enterococcus, of which enterococcus faeeium was at the most （26.59%）, and enterococcus faecalis was following （11.70%）. The cultural positive rate was highest in drainage fluid, which was followed by blood culture （the positive rates were 15.12% and 3.45% respectively）. Staphylococcus haemolyticus was mainly cultured from blood stream （40%）, staphylococcus aureus was mainly from sputum （83.33%）, and enterocoecus faecium was mainly from abdominal drainage fluid （60%）. Drug-resistance was critical in staphylococcus and enterococcus, among of which MRSA, MRSE, and MRSH accounted for 53.85%, 83.33%, and 100% respectively. One strain of MRSH was resistant to teicoplanin; none was resistant to vancomycin or linezolid. In enterococcus, one strain was resistant to linezolid, one was resistant to vancomyein, and the others were not drug-resistant. [ Conclusion ] MRS was common in ICU, the cultural rate was followed by enterococcus. The posi- tive rate was highest in drainage fluid. Multiple drug-resistances were common. Gram-positive cocci were still sensi- tive to Teicoplanin, vancomycin, and linezolid, which could be chosed in clinical practice. However, drug-resistant strains were also discovered. So, it is of importance to monitor the change of gram-positive cocci intensively.