医院尿路感染患者分离株尿肠球菌耐药性分析

Analysis of the drug resistance of Enterococcus faecium isolated from inpatients with a urinary tract infection

目的分析牡丹江地区尿肠球菌对氨基糖苷类、大环内酯类抗生素以及四环素、万古霉素等耐药情况,为临床合理用药提供依据。方法选取2011年6月-2014年6月分离自住院尿路感染患者的尿肠球菌21株,采用法国梅里埃公司API板条进行鉴定并依据CLSI采用K-B纸片扩散法进行药敏试验;根据GenBank设计引物,PCR扩增耐药基因。结果 K-B纸片扩散法检测21株尿肠球菌对常用抗生素耐药率分别为:诺氟沙星85.71%,左氧氟沙星61.90%,环丙沙星57.14%,红霉素71.43%,庆大霉素61.90%,四环素57.14%,氯霉素47.62%,利福平47.62%,利奈唑胺4.76%。未检测到万古霉素和替考拉宁耐药株。PCR检测15株含有aac(6′)/aph(2′)基因,17株含有ant(6)-Ⅰ基因,14株含有aph(3)-Ⅲ基因,11株含有ermB基因,4株检测出tetM基因,21株全部检测到efa和efm基因。未检测出vanA和vanB基因。结论临床分离株尿肠球菌耐药基因携带率较高,因此建议尿路感染治疗应根据药敏试验结果选用抗生素。在牡丹江地区,万古霉素、替考拉宁和利奈唑胺可作为治疗尿路尿肠球菌感染的一线药物。

Objective To analyze the resistance of Enterococcus faecium to aminoglycosides, macrolides, tetracyclines, and vancomycin in order to provide a reference for rational drug use in clinical practice. Methods Twenty-one strains of E. faecium that were isolated from June 2011 to June 2014 were identified using API strips. Drug sensitivity was tested using the Kirby Bauer disk diffusion method. Drug resistance genes were detected with a polymerase chain reaction and i- dentified using GenBank. Results Drug resistance to norfloxacin was 85.71%, resistance to levofloxacin was 61.90%, resistance to ciprofloxacin was 57.14~/00, resistance to erythromycin was 71.43%, resistance to gentamiein was 61.90%, resistance to tetracycline was 57.14%, resistance to chloramphenicol was 47.62%, resistance to rifampin was 47.62%, and resistance to linezolid was 4.76%. None of the strains were resistant to vancomycin or teicoplanin. The aac（6＇）/aph （2＇） drug resistance gene was found in 15 strains, the ant（6）- I gene was found in 17 strains, the aph（3）-Ⅲ gene was found in 14 strains, the ermB gene was found in 11 strains, the tetM gene was found in 4 strains, and the era gene and efm gene were found in 21 strains in total. None of the strains were found to have the vanA gene or the vanB gene. Con- clusion Clinical isolates of E. faeciurn often had drug resistance genes. A urinary tract infection should be cured after drug sensitivity testing. In this area, vancomycin, teicoplanin, and linezolid can be used as first-line drugs for the treatment of E. faecium.