自身免疫病患者革兰阳性球菌感染分布及耐药性分析

Distribution and antibiotic resistance of gram-positive cocci causing infections in autoimmune disease patients

目的探讨分析自身免疫性病患者感染革兰阳性球菌的种类分布及耐药性,为临床更有效合理使用抗菌药物治疗自身免疫性病患者感染提供依据。方法应用VITEK-32型全自动细菌分析系统仪鉴定系统对临床标本中分离出的革兰阳性球菌进行鉴定,用K-B琼脂扩散法进行药物敏感试验。结果 416例自身免疫病患者并发细菌感染181例,感染率为43.51%;共分离出病原菌273株,其中革兰阳性球菌84株,占30.77%;耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)分别占金黄色葡萄球菌和凝固酶阴性葡萄球菌(CNS)的62.83%和63.33%;药敏试验显示,MRSA对万古霉素、替考拉宁、呋喃妥因、头孢哌酮/舒巴坦及利福平的耐药率分别为0、0、15.38%、23.08%、23.08%;MRCNS对万古霉素、替考拉宁、呋喃妥因、头孢哌酮/舒巴坦及利福平的耐药率分别为0、0、10.53%、26.32%、21.05%,对其余多种抗菌药物耐药。结论自身免疫病患者感染的常见病原菌为革兰阳性球菌,其耐药率较高,抗感染治疗有一定的困难,通过细菌谱及耐药性监测对控制革兰阳性菌感染的发生有重要意义。

OBJECTIVE To study the distribution of drug resistance of the gram-positive bacteria causing infections in the autoimmune-disease patients so as to provide basis for the reasonable use of antibiotics in the treatment of autoimmune-disease patients. METHODS The identification and drug susceptibility test were analyzed by VITEK- 32 Expression automatic microbiology analytical instrument system, and the bacterial susceptibility test was performed by Kirby-Bauer agar diffusion method. RESULTS Of 416 cases of autoimmune-disease patients, 181 （43.51~） had bacterial infections. A total of 273 strains of pathogens had been isolated, among them, 84strains （30. 77~/~） were gram-positive cocci,the most commonly seen pathogens were coagulase-negative Staphylococcus, Staphylococcus aureus, and Enterococcus faecalis. The raethicillin-resistant S. aureus （ MRSA） and methicillin- resistant coagulase-negative Staphylococcus （MRCNS） accounted for 61. 90% and 63. 33%, respectively. The drug susceptibility testing showed that the drug resistance rate of MRSA to vancomycin was 0, teicoplanin 0, nitrofurantoin 15.38~/~ , cefoperazone-sulbactam 23. 08~//oo, and rifampicin 23. 08%~ the drug resistance rate of MRCNS to vancomycin was 0, teicoplanin 0, nitrofurantoin 10. 53~, cefoperazone-sulbactam 26. 32~, and rifampicin 21.05% ~ the strains were resistant to most of the rest antibiotics. CONCLUSION The gram-positive cocci are the common pathogens causing infections in the autoimmune disease patients and are highly drug resistant, which make the anti-infection therapy even difficult. It is of great significance in the control of the gram- positive bacteria infections to monitor the bacterial sDeetrlJrn ~nA th,~ A ;