肠球菌的临床感染与耐药性分析

目的了解温州医学院附属第一医院临床分离主要肠球菌的分布及其对常用抗菌药物的耐药现状，以指导临床合理用药。方法对2008年至2011年临床分离的635株粪肠球菌和屎肠球菌的标本来源和药敏结果进行回顾性分析。结果各种临床标本中两种肠球菌的分布比例存在差异，总体以尿液标本所占比例最多，且屎肠球菌的总体分离率高于粪肠球菌。粪肠球菌对利奈唑胺、氨苄西林、万古霉素、呋喃妥因和替考拉宁的耐药率都在5．0％以下，对莫西沙星和青霉素G的耐药率也仅为7．0％和6．7％；屎肠球菌对莫西沙星、左旋氧氟沙星、环丙沙星、氨苄西林、青霉素G和红霉素的耐药率都在90．0％以上，对利奈唑胺、万古霉素、替考拉宁和奎奴敏感。粪肠球菌的多重耐药株占总数的26．4％，屎肠球菌的多重耐药株占总数的78．2％。结论粪肠球菌和屎肠球菌对15种抗菌药物的耐药情况不同，屎肠球菌具有更高的耐药率和更广的耐药谱。临床应根据药敏试验的结果合理选择抗菌药物，以防止耐药菌株的产生和播散。

Clinical infection and drug-resistance analysis of Enterococcus

Objective To explore the current distribution and drug-resistance of the main types of clinically isolated Enterococci in the First Affiliated Hospital of Wenzhou Medical College to guide optimal clinical drug practice.Methods Retrospective analysis was performed with the source and antimicrobial susceptibility results of 635 strains of Enterococcus faecalis and Enterococcus faecium which were clinically isolated during 2008 to 2011.Results The ratios of the two types of Enterococci had a difference in different specimens.Most of Enterococci were isolated from urine specimens which accounted for the highest ratio in total,and the isolation rate of Enterococcus faecium was significantly higher than that of Enterococcus faecalis.The drug resistance rate of Enterococcus faecalis to linezolid,vancomycin,nitrofurantoin and teicoplanin were all under 5%,and to moxifloxacin and penicillin were 7.0% and 6.7% respectively,while the drug resistance rate of Enterococcus faecium to moxifloxacin,levofloxacin,ciprofloxacin,ampicillin,penicillin G and erythromycin were all above 90.0%.Enterococcus faecium were sensitive to vancomycin,teicoplanin and quetiapine.The multi-drug resistant strains of Enterococcus faecalis accounted for 26.4%,while that of Enterococcus faecium was up to 78.2%.Conclusion Enterococcus faecalis and Enterococcus faecium have different drug-resistance to 15 antimicrobial drugs.Enterococcus faecium has higher drug resistance rate and wider drug resistance spectrum.The antimicrobial drugs should be optimally chosen according to the results of susceptibility test to prevent the generation and contamination of drug resistant strains.