老年患者屎肠球菌感染的临床分布及耐药性分析

Clinical distribution of Enterococcus faecium infection in elderly patients and the analysis of drug resistance

目的探讨老年患者屎肠球菌感染的临床分布特点,并分析其对临床常用抗菌药物的耐药性,为临床合理治疗屎肠球菌感染提供参考依据。方法采用回顾性分析及统计分析方法,收集我院2013年1月至2015年12月期间屎肠球菌感染的老年患者(≥65岁)的临床数据,对其进行感染现状及耐药性分析。结果3年内共检出屎肠球菌感染384例,其检出率呈逐年升高趋势。屎肠球菌感染的标本类型中尿液所占比例最高,达47.14%,其次为引流液和全血标本,分别占19.53%和16.15%。在科室分布中,标本主要分离于重症监护病房(ICU)、普通外科病房和呼吸内科病房,分别占23.96%、20.57%和16.41%。药敏结果显示:屎肠球菌对氨苄西林、红霉素、环丙沙星、克林霉素、莫西沙星、青霉素G、左氧氟沙星等抗菌药物的耐药性均超过90%,而对喹奴普汀/达福普汀、替加环素、万古霉素、利奈唑胺等药物具有高度敏感性。结论屎肠球菌对不同抗菌药物的敏感性不同,且其院内感染近年有增高趋势,对屎肠球菌感染的耐药性监测,有利于指导临床合理用药。

Objective To investigate the clinical distribution characteristics of Enterococcus faecium infection in elderly patients and analyze their drug resistance to clinical use of common antibiotics in order to provide some references for the rational treatment of Enterococcus faecium infection.Methods The retrospective analysis and statistical analysis were carried out to collect the clinical data and to analyze the infection status and drug resistance in elderly patients（65 or higher）who were infected with Enterococcus faecium from January 2013 to December 2015.Results Totally 384 strains of Enterococcus faecium infection were detected in these three years and the detection rate was increased year by year.The type of specimen with highest proportion of Enterococcus faecium infection was urine（47.14%）,f ollowed by drainage fluid（19.53%）and blood（16.15%）.In the distribution of department,the specimen was mainly separated from the Intensive Care Unit（ICU）,the general surgical ward and the respiratory medicine ward,accounting for 23.96%,20.57% and 16.41%,respectively.It was demonstrated by drug sensitive test that the Enterococcus faecium had a high resistance to ampicillin,erythromycin,ciprofloxacin,clindamycin,moxifloxacin,penicillin G and levofloxacin over 90%,and a high sensitvity to quinupristin/dalfopristin,tigecycline,linezolid and vancomycin.Conclusion Enterococcus faecium has different sensitivity in different antimicrobial drugs,and the hospital infection of Enterococcus faecium has a gradually increasing trend.Monitoring the drug resistance of Enterococcus faecium infection is beneficial to guide the reasonable use of antibiotics.