湖北地区部分医院肠球菌耐药性监测及相关因素分析

目的：了解湖北地区2000年度肠球菌的分离情况及耐药状况，并对抗感染用药进行探索，指导临床合理用药。方法：对湖北地区15所三甲医院各类临床标本中的538株肠球菌采用API细菌鉴定系统或Vitek全自动细菌鉴定系统进行分离鉴定，用纸片扩散法进行药敏试验，并以WHO细菌耐药监测网提供的WHONET4软件分析系统对试验数据进行分析处理。结果：本试验共分离肠球菌13个种别538株，其中大多数是粪肠球菌408株，占75.8%,屎肠球菌54株，占10.0%；坚忍肠球菌24株，占4.46%；鸟肠球菌10株，占1.86%。酪黄肠球菌6株，占1.11%；母鸡肠球菌6株，占1.11%等。本研究结果表明肠球菌的主要感染部位为泌尿道31.4%和各种分泌物31.0%。同时从药敏结果可见屎肠球菌和坚忍肠球菌对大多数抗生素的耐药性高于粪肠球基本国策 ；并发现糖肽类抗生素耐药菌株比例尚不高；庆大霉素呈高水平耐药球菌株比例则较高；对青霉素和氨卞西林耐药，本研究结果亦有反映，并且鸟肠球菌的耐药性高于粪肠球菌近三倍。结论：本年度分离的肠球菌占全年总分离菌的第六位，说明我国目前由肠球菌引起的感染所占比例不高，但仍应引起临床的高度重视，并进行动态的监测。加强对肠球菌特别是VRR耐药性的监测是非常必要的，泌尿道肠球菌感染的抗生素中呋喃妥因的耐药率较四环素和喹诺酮类药物为低，故仍不失为治疗该类泌感的首选药物，菌株差别与地区有关，由于肠球菌属中的不同种对抗生素的敏感性不同。因此种的鉴定是对该地区医院感染暴发流行，选择治疗方案的重要工具。

SURVEY AND RELATIVE ANALYSIS IN ENTEROCOCCUS DRUG RESISTANCE IN HOSPITALS OF HUBEI

Objective:To stydy the isolation and drug resistance of Enterococcus in the 2000s in fifteen first class hospitals of Hubei to guide the clinical rational administration Methods:Isolating and prodating 538 strains of Enterococcus by APlacteria assay system or vitek bacteria assay system Using Kirby Bauer method by disc test,processing the experimental data with WHONET4 soft analysis system provided by WHO bacteria drug resistant surveillance net Results:13 species of Enterococcus have been isolated from 538 strains including 408(75 8%)isolates of E faecalis ,54(10 0%)isolates of E faecium ,24(4 46%)isolates of E durans ,10(1 86%)isolates of E avium ,6(1 11%)isolates of E casseeiflavus , the same account of E gallinarums, et al The research indicated that urinary tract infection was premier(31 4%),with all types of secretions and drains(31 0%) Kirby Bauer test showdr that E faecium and E durans resistance to most antibiotics were higher than E faecalis resistance The resistance was significant to Aminoglycosides and Polypeptides but less to Gentamicin,and to penicllin and Ampicillin The finding suggest that E avium to antibiotic resistance has 4 times higher to that of E faecalis Conclusion:The rate of infection caused by enterococcus was limited in our country in 2000 year (sixth in total isolated bacteria) It is necessary to survey enterococcus and VRE antibiotics resistance especially Nitrofurantion may be the drug of first choice for urinary tract infection as it has lower resistance than Tetracyclines and Quinolones Antibiotics should be right chosen because enterococcus strains differ among various areas as well as resistance