1000株肠球菌耐药性分析

Analysis of antimicrobial resistance of 1000 strains in enterococci

目的测定1999年1月至2002年12月临床分离的1000株肠球菌对11种抗生素的敏感性现状,为临床合理选药提供客观实验依据。方法菌株经Vitek和Microscan及常规方法鉴定,按照NCCLS推荐的纸片扩散法和判断标准进行药敏试验,并用WHONET5软件进行分析,用琼脂稀释法测定菌株的MIC值。结果粪肠球菌和屎肠球菌分离率分别占肠球菌的56.0%和41.7%;居前4位的标本依次是尿液(68.7%)、痰液(15.3%)、血液(8.3%)、脓性分泌物(6.4%)。纸片法测定结果表明粪肠球菌和尿肠球菌对万古霉素、呋喃妥因、氯霉素、红霉素、四环素、青霉素、氨苄西林、亚胺培南、高浓度庆大霉素以及环丙沙星的耐药率分别为2.2%、3.3%;10.0%、12.7%;54.5%、73.8%;82.3%、96.8%;43.3%、44.7%;17.1%、85.9%;14.9%、73.9%;13.8%、72.5%;46.0%、55.4%;34.8%、66.9%。MIC值测定结果表明头孢硫脒对粪肠球菌MIC50和MIC90分别为2和16mg/L;对屎肠球菌为16和128mg/L。万古霉素对粪肠球菌、屎肠球菌MIC50、MIC90均为2和4mg/L。结论肠球菌对万古霉素耐药率低,头孢硫脒与其它药物相比对粪肠球菌体外活性较强,对屎肠球菌活性相当,肠球菌对其余9种抗菌药物耐药率有逐年增加的趋势。

Objective To analyze the resistant tendency of clinical enterococcus isolates and to guide the rational use of antimicrobial agents. Methods Strains were identified by Automatic Microbiology and Susceptibility System.Susceptibility tests were performed by NCCLS recommended disk diffusion method.Laboratory data were analyzed by WHONET 5 statistic software.MICs were determined by agar dilution method. Results The isolation rates of E.faecalis and E.faecium were 56.0% and 41.7% respectively.The enterococcus isolates rates from urine, sputum, blood and secretion with pus were 68.7% ,15.3% ,8.3% ,and 6.4% respectively.The resistance rates of E.faecalis and E.faecium to vancomycin,nitrofurantoin,chloramphenicol,erythromycin,tetracycline,penicillin,ampicillin, imipenem,high- concentration gentamicin and ciprofloxacin were 2.2% ,3.3% ;10.0% ,12.7% ;54.5% ,73.8% ;82.3% ,96.8% ; 43.3% , 44.7% ; 17.1% , 85.9% ; 14.9% , 73.9% ; 13.8% , 72.5% ; 46.0% , 55.4% ; 34.8% , 66.9% respectively. MIC 50 and MIC 90 of cefathiamidine against E.f aecalis and E.f aecium were 2、 16mg/L; 2、 4 mg/L. Conclusions E.faecalis and E.faecium had low resistance to vancomycin.The tendency of increasing resistance to the nine antimicrobial agents was obvious year by year.