肠球菌属临床分布特征与耐药性分析

Clinical distribution and drug resistance of Enterococcus spp

目的了解肠球菌属在临床标本中的分布特点及对抗菌药物的耐药性,为临床合理使用抗菌药物提供参考。方法对医院2010-2014年临床送检的各种标本进行培养,采用VITEK-2Compact全自动微生物分析仪对分离出的1 937株肠球菌属进行鉴定,药敏分析采用VITEK-AMS系统药敏卡及K-B法;采用WHONET5.6软件对结果进行统计分析。结果在1 937株肠球菌属中,屎肠球菌1 091株占56.3%、粪肠球菌672株34.7%;屎肠球菌和粪肠球菌均以泌尿系感染最高,分别占59.9%和53.1%;2010-2014年粪肠球菌对抗菌药物的耐药率远低于屎肠球菌;除屎肠球菌及粪肠球菌对利奈唑胺耐药率较低外,屎肠球菌与粪肠球菌对万古霉素、替考拉宁的耐药率上升速度较快,由2010-2013年的1.4%、0.2%与2.2%、0.3%上升至2014年的7.3%、11.5%与4.9%、8.0%;2010-2014年屎肠球菌对青霉素、氨苄西林年之间相比变化不大,耐药率在85.0%-90.0%,明显高于粪肠球菌的9.0%-25.0%。结论肠球菌属在泌尿系感染中占重要位置;屎肠球菌耐药率明显高于粪肠球菌,应加强对耐药菌株的监测和预防控制。

OBJECTIVE To investigate the clinical distribution and drug resistance of the Enterococcus sppso as to provide guidance for reasonable clinical use of antibiotics.METHODS From 2010 to 2014,the submitted clinical specimens were cultured,then totally 1 937 strains of isolated Enterococcus were identified by using VITEK-2Compact automatic microorganism analyzer,the drug susceptibility testing was carried out by means of VITEKAMS drug susceptibility card and K-B method,and the statistical analysis was performed with the use of WHONET5.6software.RESULTS Of 1 937 strains of Enterococcus,1 091（56.3%）were Enterococcus faecium,and672（34.7%）were Enterococcus faecalis.The patients with urinary system infections caused by E.faecium accounted for 59.9%,and the patients with urinary system infection caused by E.faecalis accounted for 53.1%.The drug resistance rate of the E.faecalis was significantly lower than that of the E.faeciumin 2010-2014.The drug resistance rates of the E.faeciumand E.faecalis to linezolid were low;while the drug resistance rate of the E.faeciumto vancomycin increased from 1.4% in 2010-2013 to 7.3% in 2014;the drug resistance rate of the E.faeciumto teicoplanin increased from 2.2%in 2010-2013 to 4.9%in 2014;the drug resistance rate of the E.faecalis to vancomycin increased from 0.2%in 2010-2013 to 11.5%in 2014;the drug resistance rate of the E.faecalis to teicoplanin increased from 0.3%in 2010-2013 to 8.0%in 2014.The drug resistance rate of the E.faeciumto penicillin and ampicillin varied from 85.0%to 90.0%in 2010-2014,significantly higher than from 9.0%to 25.0% of the E.faecalis.CONCLUSIONThe Enterococcus sppis dominant among the pathogens causing the urinary system infections.The drug resistance rate of the E.faeciumis significantly higher than that of the E.faecalis.It is necessary to strengthen the surveillance of the drug-resistant strains and intensify the prevention and control.