肠球菌属医院感染的危险因素与耐药性分析

Risk factors and resistance analysis of nosocomial Enterococcusinfections

目的：探讨导致住院患者肠球菌属感染的危险因素，制定预防措施，并分析其耐药性，为临床选择抗菌药物提供参考。方法以2007-2010年以医院收治的60例肠球菌属医院感染患者为感染组，与60例非感染患者对照病例配比研究为非感染组，分析其感染因素，采用SPSS19．0软件进行统计分析。结果60例感染组患者感染部位以泌尿系统感染为主，共32例占53．3％；患者有基础疾病、入院时病情危重、合并泌尿系感染、血清白蛋白＜30 g／L、住院时间长和存在侵入性操作、前期应用抗菌药物在病例组和对照组中差异有统计学意义（ P＜0．05）；粪肠球菌对呋喃妥因、氨苄西林、青霉素G耐药率分别为13．3％、26．6％和26．6％，屎肠球菌对上述药物耐药率在53．3％-93．3％，肠球菌属对高浓度氨基糖苷类、氨苄西林／舒巴坦等耐药率偏高。结论患者入院时病情危重、血清白蛋白低水平、有侵入性操作和前期应用头孢三代抗菌药物是肠球菌属医院感染的独立危险因素；利奈唑胺、替考拉宁、万古霉素为治疗万古霉素敏感菌株感染首选用药。

OBJECTIVE To investigate the risk factors of nosocomial infections caused by Enterococcus in hospital-ized patients ,formulate preventive measures ,and analyze the resistance of Enterococcus so as to provide a reference for clinical use of antibacterial agents .METHODS A total of 60 patients with nosocomial Enterococcus infections admitted and treated during the year 2007 to 2010 were selected as the infection group and analyzed ,and another 60 non-infected patients in the paired case as the non-infection group .The infection factors were analyzed and the software SPSS19 .0 was used for statistical analysis .RESULTS The main infected site in the infection group was urinary system （32 cases ,53 .3% ） .The difference between the two groups was significant in underlying diseases ,admission condition and a merger of urinary tract infection ,albumin level 〈30 g/L ,long hospital stay ,the use of invasive procedures and the use of antimicrobial drugs in early stage .The resistance rates of Enterococcus f aecalis to nitrofurantoin ,ampicillin ,penicillin G were 13 .3% ,26 .6% and 26 .6% .The resistance rates of Enterococcus feces to the above agents were 53 .3% -93 .3% .Enterococcus had high resistance to amin-oglycosides of high concentration and ampicillin/sulbactam .CONCLUSION Admission to hospital in critical condition ,low levels of albumin ,invasive procedures and use of the third generation of cephalosporin are independent risk factors for nosocomial Enterococcus infections .Linezolid ,teicoplanin ,and vancomycin are the first choices for the treatment of infection by vancomycin-susceptible strains .