耐利奈唑胺凝固酶阴性葡萄球菌在EICU的临床分布及耐药性  

Clinical distribution and drug resistance of linezolid-resistant coagulase-negative staphylococci in EICU

作　　者：张可[1] 许秋然[1] 

机构地区：[1]浙江省人民医院急诊科,浙江杭州310014

出　　处：《中国生化药物杂志》2016年第5期195-197,200,共4页Chinese Journal of Biochemical Pharmaceutics

摘　　要：目的探讨耐利奈唑胺凝固酶阴性葡萄球菌在急诊重症监护病房（EICU）的临床分布及其耐药性的影响。方法选取在2011年1月~2015年12月期间,浙江省人民医院定植或感染了耐利奈唑胺凝固酶阴性葡萄球菌的重症患者为观察对象,对分离得到的耐利奈唑胺凝固酶阴性葡萄球菌进行了分型、耐药性研究以及其奈唑胺耐药性的形成机理研究;并进一步研究耐利奈唑胺凝固酶阴性葡萄球菌发病率与利奈唑胺使用量之间的关系。结果在研究期间,共计有49例患者根据临床标本分离出耐利奈唑胺凝固酶阴性葡萄球菌株系,其中表皮葡萄球菌有40株（81.6%）,人葡萄球菌有9株（18.4%）;药敏试验表明耐利奈唑胺凝固酶阴性葡萄球菌对青霉素、左氟氧沙星、氨苄西林的耐药性达到了90%以上,对四环素、阿莫西林、红霉素的耐药性在60%以上;耐利奈唑胺凝固酶阴性葡萄球菌在G2576T、L4、L5和L22区域出现突变的概率分别是87.5%、80%、50%和0;利奈唑胺使用量和耐利奈唑胺菌株发病率之间存在显著的相关性（R=0.293,P〈0.05）。结论耐利奈唑胺凝固酶阴性葡萄球菌对多种常见抗生素具有耐药性,说明该类细菌的耐药性问题已相当严峻;同时利奈唑胺耐药性形成机理并不单一,细菌在G2576T、L4、L5和L22区域出现基因突变均可能形成利奈唑胺耐药性;利奈唑胺使用量和耐利奈唑胺菌株发病率之间存在显著的相关性。Objective To explore the clinical distribution and drug resistance of linezolid-resistant coagulase-negative staphylococci （CONS） in intensive care unit （EICU）. Methods An observational study was conducted in critically ill patients colonized or infected by linezolid-resistant CoNS in our hospital between from January 2011 to December 2015. The epidemiolngical and clinical features, and the mechanism of resistance to linezolid. The association between the incidence of linezolid-resistant CoNS strains and the consumption of linezolid in the study period were evaluated. ResultS During the study period, 49 patients had a linezolid-resistant CoNS strain isolated from clinical sample. Forty （81.6%） isolates were identified as S. epidermidis and nine were S. hominis. The result of susceptibility testing indicated that linezolid-resistan CoNS had more than 90% resistant to penicillin, levofloxacin and ampicillin. Meanwhile, linezolid-resistan CoNS also had more than 60% resistant to tetracycline, amoxicillin and erythromycin. Molecular analysis confirmed the presence of mutation of G2576T, L3, L4 and L22 in 87.5% , 80% , 50% and 0, respectively, of the strains tested. Beside, a modest significant correlation was observed between the decrease in linezolid consumption and the lower incidence of resistant isolates. Conclusion Linezolidresistant CoNS has resistant to many kinds of antibiotic. Meanwhile, molecular analysis confirms the presence of mutation of G2576T, L3, L4 and L22 of the strains tested, which confirms that different mechanisms of resistance to linezolid could coexist. Beside, a significant correlation is found between linezolid consumption and the incidence of linezolid-resistant CoNS strains.

关 键 词：利奈唑胺耐药性 凝固酶阴性葡萄球菌 急诊重症监护病房 

分 类 号：R446.5[医药卫生—诊断学]