血流感染粪肠球菌和屎肠球菌的临床分布及耐药研究

Antimicrobial agent susceptibilities and clinical distributions of Enterococcus faecalis and Enterococcus faecium causing bloodstream infection

回顾性分析上海市某三甲医院血培养阳性标本中粪肠球菌和屎肠球菌的临床分布及对抗菌药物的耐药特征,为临床治疗其所致感染奠定基础。收集上海市某三甲医院2012年2月—2016年9月血流感染患者血液标本中的粪肠球菌和屎肠球菌,采用法国生物梅里埃公司的VITEK 2Compact全自动细菌鉴定和药敏分析系统进行细菌鉴定及药敏测定,研究细菌临床分布特点及对常用抗菌药物的耐药特征。共分离获得30株粪肠球菌和17株屎肠球菌。粪肠球菌样本主要来自泌尿科、消化科和血液科,所占比例分别为13.33%、16.67%和10.00%。粪肠球菌对青霉素、氨苄西林、环丙沙星、左氧氟沙星、四环素和红霉素的耐药率分别为13.33%、10.00%、36.67%、33.33%、66.67%和60.00%。屎肠球菌样本主要来自消化科(29.41%),其对以上抗菌药物的耐药率分别为88.24%、82.35%、88.24%、76.47%、23.53%和70.59%。屎肠球菌对青霉素、氨苄西林、环丙沙星和左氧氟沙星的耐药率显著高于粪肠球菌,而对四环素的耐药率显著低于粪肠球菌。两者均对替加环素、利奈唑胺和万古霉素敏感,但万古霉素对屎肠球菌的最低抑菌浓度显著低于粪肠球菌。结果提示,屎肠球菌对青霉素、氨苄西林、环丙沙星、左氧氟沙星的耐药率高于屎肠球菌,对万古霉素敏感,且其万古霉素最低抑菌浓度低于粪肠球菌。本研究为治疗这两种细菌所致感染的经验性用药提供了数据支持。

The present paper aims to retrospectively analyze the antimicrobial agent susceptibilities and clinical distributions of Enterococcus faecalis（E.faecalis）and E.faecium causing bloodstream infection in a tertiary hospital in Shanghai,and to lay a foundation for the clinical treatment of infections caused by these bacteria.The collected strains of E.faecalis and E.faecium were isolated between February 2012 and September 2016.The bacteria were identified by bioMérieux VITEK antimicrobial susceptibility testing system,and their clinical distribution and drug resistance were analyzed.Thirty E.faecalis and 17 E.faecium strains were obtained.E.faecalis strains were mainly from urology,gastroenterology and hematology departments,accounting for 13.33%,16.67% and 10.00%,respectively.The resistance rates of E.faecalis to penicillin,ampicillin,ciprofloxacin,levofloxacin,tetracycline and erythromycin were13.33%,10.00%,36.67%,33.33%,66.67% and 60.00%,respectively.The resistance rates of E.faecium to these antimicrobial agents were 88.24%,82.35%,88.24%,76.47%,23.53% and 70.59%,respectively.The resistance rates of E.faecium to penicillin,ampicillin,ciprofloxacin and levofloxacin were significantly higher than those of E.faecalis and the resistance rate to tetracycline was significantly lower than that of E.faecalis.Most of the E.faecium（29.41%）samples were from gastroenterology department.Both were sensitive to tigecycline,linezolid and vancomycin. However,the minimum inhibition concentration of vancomycin against E.faecium was significantly lower than that of E.faecalis.This study provided data support for the empirical treatment of infections caused by the two bacteria.