致血流感染的肠球菌耐药现状及分子流行特征的研究  

The antibiotics resistance analysis and molecular epidemiology of Enterococcus isolated from blood culture

作　　者：李东冬[1] 陈荣[1] 沈定霞[1] 褚佳琪 

机构地区：[1]中国人民解放军总医院微生物科,北京100853

出　　处：《中国抗生素杂志》2014年第5期370-374,共5页Chinese Journal of Antibiotics

基　　金：首都医学发展科研基金资助(2009-1023)

摘　　要：目的了解引起血流感染肠球菌的种类、对高浓度氨基糖苷类的耐药性及耐万古霉素肠球菌的耐药基因和分子流行特征。方法选取2008—2012年发生肠球菌血流感染患者的血培养分离株,进行菌种鉴定和药敏试验。用PCR方法对其中的耐万古霉素肠球菌的耐万古霉素基因进行检测以,脉冲场凝胶电泳对耐万古霉素肠球菌进行分子分型。结果在5年间共分离到肠球菌属细菌211株中,屎肠球菌161株,占76.3%,粪肠球菌50株,占23.7%。经琼脂稀释法筛选出耐高浓度氨基糖苷类肠球菌144株,占71.6%。检测到耐万古霉素的肠球菌9株,均携带有vanA基因,未检测到vanB基因。脉冲场凝胶电泳分型的结果显示,耐万古霉素的肠球菌各菌株具有不同的分子表型。多位点序列分型的结果显示,9株耐万古肠球菌株分别属于ST78(7/9)、ST192(1/9)和ST804(1/9)型。结论肠球菌引起的血流感染以屎肠球菌为主,呈多重耐药性,致血流感染的耐万古霉素肠球菌之间没有相似性,其中的8株耐万古霉素肠球菌的多位点序列分型属于CC17克隆复合体。Objective To analyze Enterococcus isolated from blood stream infection, included the antibiotics susceptibility profiles, distribution and molecular epidemiology ofvancomycin resistant enterococcus（VRE）. Methods Enterococcus was isolated from clinical patients＇ blood culture indentified to species level. The antibiotic susceptibility testing during the period from 2008 to 2012. All strains were was done according to the newest CLSI. van genotype determination was detected by PCR, pulsed field gel electrophoresis （PFGE）was used to genetype VRE strains. Multi- locus sequence typing was used to determine the STs of VRE strains. Results In total 211 strains were analyzed, including 161 strains ofE. faecium and 50 strains ofE. faecalis. Among the 211 strains, 71.6% were high level aminoglycosides resistant enterococcus through agar dilution method. In this research VRE were all vanA genotype, their PFGE result demonstrated significant diversity in restriction fragment length. Multilocus sequence typing showed 9 VRE strains belong to ST78（7/9）, ST192（1/9）, ST804（1/9）, respectively. Conclusion The isolate ofE. faecium are more than E. faecalis, and the isolate rate ofE. faeeium is rising. Among these isolates, multi-drug resistant strains are common. All VRE had a unique PFGE pattern, suggesting VRE blood stream infection was endemic. Eight out of nine strains belonged to CC 17 clonal complex.

关 键 词：血流感染 肠球菌属 脉冲场凝胶电泳 多位点序列分型 

分 类 号：R378[医药卫生—病原生物学]