2010-2012年革兰阳性球菌的分布及耐药性变迁

Distribution and drug resistance of clinical isolates of major gram-positive cocci

目的了解医院2010-2012年临床分离主要革兰阳性球菌的分布及耐药性变迁,为临床用药提供依据。方法收集2010-2012年418例住院患者各类标本中分离的革兰阳性球菌相关资料进行回顾性分析,细菌鉴定采用API系统,细菌对药物敏感性测定采用纸片扩散法;WHONET5.6软件进行数据分析。结果 2010-2012年分离革兰阳性球菌418株,其中葡萄球菌属占79.9%,肠球菌属占13.4%,链球菌属占6.7%;耐甲氧西林金黄色葡萄球菌(MRSA)检出率3年分别为68.6%、52.3%、64.1%,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率3年分别为84.1%、75.4%、74.3%;MRSA对抗菌药物耐药性显著高于甲氧西林敏感金黄色葡萄球菌(MSSA),MRCNS对哌拉西林/他唑巴坦和阿米卡星敏感率较高,未发现利奈唑胺、万古霉素和替考拉宁耐药株;肠球菌属对青霉素、红霉素、左氧氟沙星和氨苄西林耐药率>50.0%,链球菌属对青霉素和红霉素耐药率均>70.0%,未发现对万古霉素和替考拉宁耐药株。结论 2010-2012年分离出的革兰阳性球菌对抗菌药物耐药性呈上升趋势,加强医院感染病原菌耐药性监测,及时了解耐药性变迁,对指导临床合理使用抗菌药物及减缓耐药菌的产生尤为重要。

OBJECTIVE To understand the distribution of clinical isolates of major gram-positive cocci in Jiangsu Shengze Hospital in 2010-2012 and analyze the change of drug resistance so as to provide guidance for clinical use of antibiotics. METHODS From 2010 through 2012, the related data of the gram-positive cocci isolated from various specimens obtained from 418 hospitalized patients were retrospectively analyzed, then the bacterial identification was performed with the use of API system, the drug susceptibility testing was conducted by means of disk diffusion method, and the data were analyzed by using WI-IONET5.6 software. RESULTS A total of 418 strains of gram-positive cocci have been isolated from 2010 to 2012, among which the Staphylococcus spp accounted for 79.9 %, the Enterococcus sppl3.4%, the Streptococcus spp6.7 %. The isolation rate of the methicillin-resistant Staphylococcusaureus（MRSA） was 68.6% in 2010, 52. 3% in 2011, 64. 1% in 2012; the isolation rate of the methieillin-resistant coagulase-negative Staphylococcus（MRCNS） was 84.1% in 2010, 75.4% in 2011, 74.3% in 2012. The drug resistance rate of the MRSA was significantly higher than that of the methieillin-suseeptible Staphylococcus aureus（MSSA） ; the MRCNS was highly susceptible to piperacillin-tazobaetam and amikaein;no strain resistant to linezolid, vancomycin, or teicoplanin has been detected; the drug resistance rates of the Enterococcus spp to penicillin, erythromycin, levofloxacin, and ampieillin were more than 50.0% ; the drug resistance rates of the Streptococcus spp to penicillin and erythromycin were more than 70.0% ; no strain resistant to vancomycin or teieoplanin has been detected. CONCLUSION The drug resistance rates of the isolated gram-positive cocci show an upward trend. It is crucial for the reasonable clinical use of antibiotics and delay of emergence of drug-resistant strains to strengthen the surveillance of drug resistance of the pathogens causing nosocomial infections and understand the change of drug resistance in a timely manner.