利奈唑胺治疗患者肠道耐药肠球菌定植观察

The Investigation of Intestinal Enterococci Colonization in the Patients Treated with Linezolid

目的:分析利奈唑胺(LZD)抗感染治疗过程中患者肠道LZD耐药肠球菌定植情况,为预防耐药肠球菌播散提供临床参考。方法:选取2016年8月至2016年12月深圳大学南山医院住院并使用LZD治疗患者15例,分析患者临床资料,采集用药前后各时间段患者粪便标本,采用选择性培养基筛选肠球菌及LZD耐药肠球菌,E.–test法检测肠球菌LZD药敏,采用聚合酶链反应技术(PCR)检测LZD耐药相关基因,包括23S rRNA基因V区、cfr、cfr(B)及optr A基因片段。结果:15例LZD治疗患者多数有长期慢性内科疾病病史或手术史,其使用LZD前均有抗生素使用史。肠道定植肠球菌检出率随着LZD用药时间延长而逐渐减少,其中2例患者在用药前检出LZD耐药肠球菌,随着用药1周肠道LZD耐药肠球菌亦分离不到,两例患者分离到的LZD耐药肠球菌均检测到optr A基因阳性。结论:LZD治疗患者肠道存在LZD耐药定植肠球菌分离阳性患者,LZD使用可以去除定植菌但定植菌是否具有耐药传播的临床意义有待明确。

Objective To analyze the intestinal enterococci colonization during the treatment of linezolid, in order to provide clinical reference for the rational use of linezolid and prevent linezolid resistant Enterococcus spread. Methods 15 patients were analyzed the clinical data who were treated by linezolid in Shenzhen Nanshan Hospital from April 2016 to Desember 2016. The clinical data of patients were studied. The stool specimens were collected, then screened out the Enterococcus and linezolid resistant Enterococcus. The minimum inhibitory concentrations （MICs） were determined by E.test method. Then their chromosome and plasmids DNA were extracted. The resistance genes including domain V of the 23S rRNA gene, cfr, cfr（B） gene as well as optrA gene were amplified by polymerase chain reaction （PCR） . Results The majority of the linezolid treated patients had chronic medical disease or receiving surgery. They all used antibiotics before treated by linezolid. The detection rate of Enterococcus was decreased gradually with the prolongation of medication time, among which 2 cases of LZD resistant Enterococcus were detected. Conclusion LZD resistance Enterococcus faecalis were isolated from LZD treatmented patients intestine. Linezolid can be used to remove the colonization of Enterococus, but the clinical significance of removing colonization remains to be clarified.