老年患者肠球菌感染的临床分布特点及耐药性对比分析

A comparative study on clinical characteristic and antibiotic resistance of E. faecalis and E. faecium infections in elderly patients

目的了解老年患者肠球菌感染的临床分布特点及耐药性,为临床合理用药提供参考依据。方法收集中国医科大学附属盛京医院2016年1月至12月期间246例老年患者感染标本中分离出的肠球菌,采用回顾性分析方法,统计临床数据并进行分析。结果共检出278株肠球菌,其中粪肠球菌84例,占30. 22%,屎肠球菌182例,占65. 47%。两类肠球菌均主要分离于尿液、全血、引流液和胆汁中。屎肠球菌主要分离于重症监护室、普通外科、泌尿外科和呼吸内科,而粪肠球菌主要分离于普通外科和泌尿外科。屎肠球菌对于红霉素,莫西沙星,环丙沙星,左氧氟沙星,青霉素G,氨苄西林的耐药率高达90%以上。而粪肠球菌对于上述抗生素(除红霉素外)的耐药率均低于50%。粪肠球菌对四环素,喹努普汀/达福普汀和利福平的耐药率高于屎肠球菌。两者对于克林霉素的耐药率均高达100%。共检测出耐万古霉素的屎肠球菌两株以及耐利奈唑胺的屎肠球菌和粪肠球菌各一株。结论老年患者中屎肠球菌对多种抗菌药物的耐药率显著高于粪肠球菌,并且已经出现了耐万古霉素和利奈唑胺的菌株,应根据药敏结果合理选用抗菌药物,提高治疗效果。

Objective To investigate the clinical distribution and drug resistance of Enterococcus spp of elderly patients in Shengjing Hospital of China Medical University so as to provide guidance for clinical reasonable use of antibiotics.Methods A retrospective analysis was carried out to figure out the clinical data and analyze the infection status and drug resistance of Enterococcus spp isolated from Jan.2016 to Dec.2016 of elderly patients in our hospital.Results There were 278 strains of Enterococcus spp isolated from the samples,including 84 strains of E.faecalis and 182 strains of E.Faecium.Both of them mainly came from urine,blood,drainage fluid and bile.E.Faecium were mainly isolated from the intensive care unit,the department of general surgery,the department of urinary surgery and the department of respiratory,while E.faecalis were isolated from the department of general surgery and the department of urinary surgery.The susceptibility tests showed that the drug resistence rates of E.faecium to erythrocin,moxifloxacin,ciprofloxacin,levofloxacin,penicillin and ampicillin were more than 90%.The resistance of E.faecalis to antibiotics(except erythromycin)above were less than 50%.But to tetracycline,quinupristin-dalforpristin and rifampicin,the drug resistance rates of E.faecalis were higher than those of E.faecium.Both of them were resistant to clindamycin and the rate were 100%.In our hospital,two vancomycin resistant E.faecium,one linezolid resistant E.Faecium and one linezolid resistancet E.faecalis were found.Conclusion Overall,the drug resistance of E.faecium to many antimicrobial agents were significantly higher than E.faecalis,and some vancomycin resistant Enterococcus and linezolid resistant Enterococcus have been selected.The antimicrobial agents should be chosen reasonably according to the results of the drug susceptibility in order to improve treatment effect.