儿童肠球菌耐药表型和耐药基因检测分析  

Detection for phenotype and genetype of the enterococci in children

作　　者：吕萍[1] 徐樨巍[1] 宋文琪[1] 董方[1] 杨永弘[1] 沈叙庄[1] 

机构地区：[1]首都医科大学附属北京儿童医院,北京100045

出　　处：《中国实用儿科杂志》2009年第12期937-939,共3页Chinese Journal of Practical Pediatrics

基　　金：国家科技部十五攻关课题基金资助(2004BA720A09-01)

摘　　要：目的研究儿童粪肠球菌和屎肠球菌的耐药表型及多种耐药基因。方法对2004年7月至2005年11月北京儿童医院门诊和住院患儿临床标本中分离的152株病原菌,采用琼脂稀释法测定肠球菌的最低抑菌浓度(MIC),聚合酶链反应检测ermB、mefA、TetM、TEM、aac(6')-aph(2″)、an(t6)-I基因。结果屎肠球菌对氨苄西林、阿莫西林/克拉维酸、环丙沙星的耐药率分别为96.8%、95.2%和84.1%,粪肠球菌对上述3种抗生素的耐药率分别为23.6%、18.0%和49.4%,屎肠球菌的耐药率明显高于粪肠球菌(P<0.001);肠球菌高水平庆大霉素耐药(HLGR)和高水平链霉素耐药(HLSR)检出率高,屎肠球菌中HLGR和HLSR的比例分别为84.1%和66.3%,分别高于粪肠球菌的68.3%和49.4%;粪肠球菌出现2株万古霉素MIC为8mg/L,粪肠球菌和屎肠球菌对替可拉宁全部敏感。肠球菌中耐药基因检出率高,粪肠球菌中ermB、TetM、aac(6')-aph(2″)、an(t6)-I基因检出率分别为73.0%、64.1%、84.3%和64.9%,高于屎肠球菌的57.1%、59.5%、82.5%和58.7%;仅有1株屎肠球菌检测到mefA基因,屎肠球菌TEM基因检出率高于粪肠球菌。结论儿童肠球菌的耐药状况十分严重,肠球菌对多种抗菌药物耐药率高,屎肠球菌耐药比粪肠球菌严重。Objective To detect the drug resistant phenotype and drug resistant genetype of the enterococci in children. Methods Agar dilution was used to study the drug resistance and polymerase chain reaction was used to test ermB, mefA , TetM, TEM, aae （6′） -aph （2″） and ant （6） -I gene. Results The resistant rate of E.faeeium toampicillin, amoxicillin-clavulanic acid,ciprofloxacin, rifampin, high level gentamicin and streptomycin were higher than E.faecalis. The resistant rate of E.faecium to chloramphenicol was higher than E.faeealis.The MIC of vancomycin was 8ug/ml in two E.faeealis.In E.faecalis and E.faecium isolates were all susceptible to teicoplanin.High rates of antibiotic resistance genes were found.The detectable rate of ermB, TetM aac （6′）-aph （2″） and ant （6）-I gene in E.faecalis was higher than in E.faecium. In only one E.faecium was found MefA. The detecable rate of TEM in E.faecium was higher than in E. faecalis. Conclusions The antimicrobial resistant status of the enterococci is very serious.High rate of antibiotic resistance for multiple antibiotics were found in enterococci, the antibioticresistante rate in E.faecium is higher than in E. faecalis.

关 键 词：肠球菌 抗生素 耐药性 

分 类 号：R72[医药卫生—儿科]