耐万古霉素屎肠球菌的流行病学及耐药性分析  

Epidemiological profiles and drug resistance analysis of vancomycin-resistant Enterococcus faecium clinical isolates

作　　者：刘平娟 陈怡丽[1] 郭鹏豪[1] 邓间开 伍众文[1] 彭雅琴 黄彬[1] 廖康[1] Liu Pingjuan;Chen Yii;Guo Penghao;Deng Jiankai;Wu Zhongwen;Peng Yaqin;Huang Bin;Liao Kang(Department of Laboratory Medicine,First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080)

机构地区：[1]中山大学附属第一医院检验科,广州510080

出　　处：《中国抗生素杂志》2024年第9期1057-1062,共6页Chinese Journal of Antibiotics

基　　金：广东省医学科学技术研究基金项目(No.C2023048)。

摘　　要：目的探讨本中心耐万古霉素屎肠球菌的流行病学及耐药性,为临床合理用药及感控防治提供科学依据。方法回顾性分析中山大学附属第一医院2017年1月—2023年6月临床分离的104株非重复的耐万古霉素屎肠球菌(vancomycin-resisitant Enterococcus faecium,VRE-fm),分析患者的基本资料、标本类型分布及对不同抗生素的耐药率、菌株携带的耐药基因及毒力基因。结果共分离104株非重复的VRE-fm菌株,≥60岁患者占63.4%(66/104);VRE-fm菌株主要分离自尿液54.8%、引流液14.4%和血液7.7%;微量肉汤稀释法药敏试验结果显示,104株VRE-fm对利奈唑胺全部敏感,替加环素的敏感率为98.1%,对其他抗菌药物敏感性较差;本中心47株VRE-fm菌株进行全基因组测序结果显示,均携带vanA耐药基因,未检出vanB和vanM耐药基因;47株VRE-fm菌株全部携带acm毒力基因,仅有1株VRE-fm菌携带esp毒力基因,其余毒力基因均为阴性。结论目前VRE-fm菌株的耐药性严峻,VRE-fm菌株通常同时携带耐药基因和毒力基因,临床可用于治疗VRE-fm感染的药物非常有限。因此,应当加强对万古霉素等糖肽类抗菌药物的使用管理,努力开发和实施感染控制方法,以有效地防止VRE-fm的进一步发生和蔓延。Objective To explore the epidemiology and drug resistance of vancomycin-resistant Enterococcus faecalis in our center and provide a scientific basis for rational drug use and infection control in clinical practice.Methods A retrospective analysis was conducted on 104 non-repetitive vancomycin-resistant Enterococcus faecalis(VRE-fm)strains clinically isolated from the First Affiliated Hospital of Sun Yat-sen University from January 2017 to June 2023.The patient's basic information,sample type distributions,resistance rates to different antibiotics,and resistance and virulence genes carried by the strains were analyzed.Results A total of 104 non-repetitive VRE-fm strains were isolated,with 63.4%(66/104)of patients aged≥60 years old;VRE-fm strains were mainly isolated from urine(54.8%),drainage(14.4%),and blood(7.7%).The results of the microbroth dilution method drug sensitivity test showed that 104 strains of VRE-fm were all sensitive to linezolid,and the sensitivity rate to tigecycline was 98.1%,with poor sensitivity to other antibacterial drugs.The whole genome sequencing results of 47 VRE-fm strains in our center showed that they all carried vanA resistance genes,but no vanB or vanM resistance genes were detected.All 47 VRE-fm strains carried acm virulence genes,with only 1 VRE-fm strain carrying esp virulence genes,and all other virulence genes were negative.Conclusion Currently,VRE-fm strains exhibit severe drug resistance,typically carrying both drug resistance genes and virulence genes.Consequently,the number of drugs available for clinical treatment of VRE-fm infections is extremely limited.Hence,it is imperative to enhance the management of the use of glycopeptide antimicrobial drugs such as vancomycin and strive to develop and implement infection control methods to effectively prevent the further occurrence and spread of VRE-fm.

关 键 词：耐万古霉素屎肠球菌 细菌耐药性 流行病学 耐药基因 毒力基因 

分 类 号：R978.1[医药卫生—药品]