血流感染肠球菌属细菌的临床分布及耐药性分析  

Clinical and microbiological characteristics of 32 cases of enterococcal bloodstream infection

作　　者：石作珍[1] 邹翠美[1] 王惠云[1] 张俭[1] 丁立新[1] 

机构地区：[1]宁夏银川市第一人民医院检验科,宁夏银川750001

出　　处：《宁夏医学杂志》2015年第9期833-835,共3页Ningxia Medical Journal

基　　金：宁夏卫生厅重点科研计划项目(2013072)

摘　　要：目的分析血流感染肠球菌属细菌感染的临床分布及其对抗菌药物的耐药状况,并检测其耐药基因,了解其耐药机制,为临床治疗提供依据。方法收集血培养检出的肠球菌属细菌,应用全自动微生物分析仪(VITEK-2 COMPACT)鉴定到种,采用K-B琼脂纸片扩散法进行药物敏感试验,试验结果采用WHONET 5.6和SPSS 17.0软件进行统计分析,并采用PCR对其耐药基因进行检测。结果 32株肠球菌属细菌中包括屎肠球菌18株(56.3%),粪肠球菌14株(43.7%),其中肝胆外科、肾脏内科、ICU的分离率列前3位;粪肠球菌与屎肠球菌的耐药谱有差异有统计学意义,但两者对万古霉素、替考拉宁、利奈唑胺的耐药率均较低。14株粪肠球菌中,阳性基因tem、aac(6')/aph(2″)、aph(3')-Ⅲ、ant(6')-Ⅰ、ant(2″)-Ⅰ、tet M、erm B的检出率依次为0、35.7%、35.7%、21.4%、35.7%、50%、21.4%,18株屎肠球菌中tem、aac(6')/aph(2″)、aph(3')-Ⅲ、ant(6')-Ⅰ、ant(2″)-Ⅰ、tet M、erm B检出率依次为11.1%、61.1%、33.3%、27.8%、44.4%、55.6%、22.2%。结论医院血流感染的肠球菌属感染以屎肠球菌为主,其耐药率明显高于粪肠球菌;耐药基因的存在是细菌产生耐药的重要原因,监测肠球菌属的临床分布及耐药状况对临床治疗具有重要的指导意义。Objective To evaluate the clinical and microbiological characteristics of enterococcal bloodstream infections,and detect the resistance genes to understand its resistance mechanisms in order to treat infection diseases rationally in clinical practice.Methods 32 isolates of enterococcal bloodstream infections were collected in our hospital and all the isolates were identified by VITEK microbe automatic system. The antibacterial agent susceptibility test was performed by the disc diffusion method（K- B） in according with the CLSI standards and the results were analyzed by the WHONET 5. 6 and SPSS 17. 0. And their resistance genes were detected by using PCR. Results Among 32 bacteria strains of enterococci,there were 18 strains of E. faecium（56. 3%）,14 strains of E. faecalis（43. 7%）. Among 32 isolates,most of them were isolated from department of nephrology,hepatobiliary surgery and ICU. The spectrum of antibacterial agent- resistant E. faecalis was significant difference with the E. faecium,compared with other widely- used antibiotics,the rates of resistance to vancomycin,teicoplanin and linezolid were lower. In E. faecalis,the detectable rates of the positive gene tem,aac（6 ＇） /aph（2″）,aph（3＇）- Ⅲ,ant（6）- Ⅰ,ant（2″）- Ⅰ,tet M,erm B were respectively 0,35. 7%,35. 7%,21. 4%,35. 7%,50. 0%and 21. 4%,but in E. faecium,the rates were respectively 11. 1%,61. 1%,33. 3%,27. 8%,44. 4%,55. 6% and 22. 2%.Conclusion E. faeciumis responsible for the enterococcal bloodstream infections. E. faecium strains have higher resistance rates to most antimicrobial agents test than E. faecalis. The important reason of resistance is the presence of resistance genes in bacterial. Therefore,monitoring the rate of resistance of enterococci to multiple antibacterial agents shows great significance to the treatment of infection diseases.

关 键 词：血流感染肠球菌 屎肠球菌 粪肠球菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学]