2010-2012年革兰阳性球菌耐药现状调查与耐药性变迁分析

Current status of drug resistance of gram-positive cocci and change of drug resistance from 2010 to 2012

目的对医院2010—2012年革兰阳性球菌耐药现状与变迁进行分析，为控制医院感染和指导临床用药提供参考依据。方法对医院门诊、住院临床送检标本进行分离培养细菌，药敏试验使用纸片扩散（K—B）法进行，药敏试验的方法与标准判定按美国临床实验室标准化研究所规定进行，所有数据使用WHONET5．5软件进行统计分析。结果共分离出886株革兰阳性球菌，葡萄球菌属567株、肠球菌属187株、链球菌属76株，其他菌属56株；3年金黄色葡萄球菌和凝固酶阴性葡萄球菌对青霉素G、苯唑西林、红霉素、环丙沙星的耐药率均〉60．0％，对庆大霉素和磺胺甲嗯唑／甲氧苄啶的耐药率35．0％～60．0％，未发现耐万古霉素的菌株；粪肠球菌对庆大霉素的耐药率〉35．0％，屎肠球菌对青霉素G、氨苄西林、左氧氟沙星、庆大霉素和链霉素的耐药率均〉35．0％，粪肠球菌和屎肠球菌对万古霉素均出现了耐药菌株。结论金黄色葡萄球菌和凝固酶阴性葡萄球菌均出现了多药耐药性，而替考拉宁、利奈唑胺和万古霉素仍是治疗多药耐药性葡萄球菌属感染的重要药物，而肠球菌属对于抗菌药物的耐药性越来越严重，临床用药时需加以重视。

OBJECTIVE To investigate the current status of drug resistance of the gram-positive cocci and analyze the change of drug resistance from 2010 to 2012 so as to provide guidance for control of nosocomial infection and clinical use of antibiotics. METHODS The submitted specimens from the outpatient department and inpatient department were cultured, then the drug susceptibility testing was performed with the K-B method, the result was determined according to the standards of CLSI, and the data were statistically analyzed by WHONET 5. 5 software. RESULTS A total of 886 strains of gram-positive cocci were isolated, including 567 strains of Staphylococci, 187 strains of Enterococci, 76 strains of Streptococci, and 56 strains of other genera. During the three years, the drug resistance rates of Staphylococcus aureus and coagulase-negative Staphylococcus to penicillin G, oxacillin, erythromycin, and ciprofloxacin were more than 60. 0 %; the drug resistance rates to gentamicin and sulfamethoxazole-trimethoprim varied between 35. 0 % and 60. 0 %; the vancomycin-resistant strain was not detected; the drug resistance rate of the Enterococcus feces to gentamicin was more than 35. 0 %, while the drug resistance rates of the Enterococcus faecalis to penicillin G, ampicillin, levofloxacin , gentamicin, and streptomycin were more than 35. 0 %; the vancomycin-resistant E. feces or E. faecalis strains were emerged. CONCLUSION S. aureus and coagulase-negative Staphylococcus show multidrug-resistance , teicoplanin, linezolid, and vancomycin remain the important antibiotics for the treatment of multidrug-resistant Staphylococci infection. The drug resistance of the Enterococci to strong antibiotics has become increasingly serious, which should be attached great importance to.