粪肠球菌和屎肠球菌耐药性分析

Analysis of Drug Resistance of Enterococcus Faecalis and Enterococcus Faecium

目的了解屎肠球菌和粪肠球菌对抗菌药物的耐药情况,为临床合理用药提供依据。方法收集我院2014年1月-2018年12月临床分离的1068株屎肠球菌和487株粪肠球菌,采用MA120细菌鉴定/药敏分析系统进行菌株鉴定,仪器法联合Kirby-Bauer纸片法进行药敏试验及耐药性分析。结果屎肠球菌和粪肠球菌5年间无利奈唑胺耐药菌株出现,对万古霉素、替考拉宁保持高度敏感,屎肠球菌和粪肠球菌对万古霉素的耐药率分别为1.50%、0.41%。屎肠球菌对青霉素、氨苄西林、环丙沙星、左氧氟沙星、红霉素的平均耐药率均>80%,对氯霉素保持低耐药率,对青霉素、氨苄西林、环丙沙星、左氧氟沙星的耐药率不同年份呈上升趋势,对四环素、利福平耐药率呈下降趋势(P<0.05)。粪肠球菌对红霉素和四环素的平均耐药率均>70%,对青霉素、氨苄西林、呋喃妥因的平均耐药率均<3%,对左氧氟沙星和环丙沙星耐药率不同年份呈上升趋势(P<0.05)。屎肠球菌对青霉素、氨苄西林、左氧氟沙星、环丙沙星、呋喃妥因耐药率高于粪肠球菌,粪肠球菌对四环素和氯霉素的耐药率高于屎肠球菌(P<0.05)。尿液标本屎肠球菌对抗菌药物的耐药率高于非尿液标本(P<0.05)。结论肠球菌对万古霉素、利奈唑胺、替考拉宁仍保持较好的敏感性,但对多种抗菌药物的耐药性呈上升趋势,且屎肠球菌耐药现状严重,故临床应根据药敏结果合理选择抗菌药物。

Objective To investigate drug resistance of enterococcus faecalis and enterococcus faecium to antibiotics in order to provide basis for rational administration in clinic. Methods A total of 1068 strains of enterococcus faecium and 487 strains of enterococcus faecalis isolated during January 2014 and December 2018 were collected. The strains were identified by MA120 system and drug sensitive analysis system. Antimicrobial susceptibility testing was carried out by using instrument method combined with Kirby-Bauer method. Drug resistance analysis was also performed. Results No Linezolid-resistant strains was found during 5 years in this study, and the strains had kept highly susceptible to Vancomycin and Teicoplanin. Resistance rates of enterococcus faecium and enterococcus faecalis to Vancomycin were 1.50% and 0.41% respectively. Resistance rates of enterococcus faecium to Penicillin, Ampicillin, Ciprofloxacin, Levofloxacin and Erythromycin were more than 80%, but resistance rate of enterococcus faecium to Chloramphenicol kept low, and its resistance rates to Penicillin, Ampicillin, Ciprofloxacin and Levofloxacin showed increased tread in different years, while its resistance rates to Rifampicin and Tetracycline showed decreased tread(P<0.05). Mean resistance rates of enterococcus faecalis to Erythromycin and Tetracycline were more than 70%, and its mean resistance rates to Penicillin, Ampicillin and Nitrofurantoin were lower than 3%, and its resistance rates to Ciprofloxacin and Levofloxacin showed increased trend in different years(P<0.05). Resistance rates of enterococcus faecium to Penicillin, Ampicillin, Levofloxacin, Ciprofloxacin and Nitrofurantoin were higher than those of enterococcus faecalis, while resistance rates of enterococcus faecalis to Tetracycline and Chloramphenicol were higher than those of enterococcus faecium. Resistance rate to antiseptics between enterococcus faecium strains isolated from urine specimens was significantly higher than that in non-urine specimens. Conclusion Enterococcus keeps better sensitivities to Vancomycin, Linezolid and Teicoplanin, but its resistance rates to many kinds of antibiotics show increased trend, and enterococcus faecium has high resistance to antibiotics, and therefore it is necessary to reasonable use of antibiotics based on results of antimicrobial susceptibility testing.