2003～2007年血培养中肠球菌分离情况及耐药分析.docVIP

2003～2007年血培养中肠球菌分离情况及耐药分析 　 作者：郭靓 范红 陈知行 陶传敏 陈慧莉 【摘要】 目的 了解近5年我院血培养中肠球菌的分离率及药敏情况，为临床经验治疗和研究提供参考。方法 收集我院2003～2007年住院患者血培养中肠球菌属的数量及药敏试验结果，并就细菌的分布及耐药性作分析。结果 2775份临床血培养阳性标本中肠球菌97株，5年平均分离率为3.49%。菌种以屎肠球菌为主(58.76%)，其次是粪肠球菌(31.96%)。检出率较高的科室是ICU科(20.62%)、外科(19.59%)和血液科(15.46%)。屎肠球菌对青霉素、氨苄西林、红霉素高度耐药；粪肠球菌对青霉素、阿莫西林/克拉维酸敏感。尚未发现耐万古霉素的肠球菌。结论 我院血培养中常见的肠球菌是屎肠球菌，其耐药率明显高于粪肠球菌。青霉素、阿莫西林/克拉维酸、氨苄西林仍然是治疗本地粪肠球菌感染的首选。对屎肠球菌或粪肠球菌引起的感染，万古霉素仍是最敏感的药物。 【关键词】 血培养； 肠球菌； 细菌耐药性 ABSTRACT Objective To analyze the distribution and resistance of Enterococcus spp.isolated from blood during 2003～2007 in Huaxi hospital. Method Clinical characteristics and the drug resistance of isolates of Enterococcus spp. were analyzed. Results The 97 definitive strains of Enterococcus spp. isolated from 2,775 blood specimens were colleted. The isolates were mainly E.faecium (58.76%), and secondly were E.faecalis (31.96%). The highest isolated ratio of Enterococcus was ICU (20.62%), followed by surgery (19.59%) and hematology departments (15.46%) respectively. The E.faecium were highly resistant to penicillin, ampicillin and erythromycin; the E.faecalis were sensitive to penicillin and amoxicillin/clavulanate. No strains resistant to vancomycin were found. Conclusion Isolation of E.faecium were more than that of E.faecalis. The resistance rates of E.faecium was higher than that of E.faecalis. Amoxicillin/clavulanate, ampicillin and penicillin were the first choice to treat local patients with E.faecalis infections. Whether E.faecium or E.faecalis infections, vancomycin was the best for choice. KEY WORDS Blood specimen; Enterococcus; Bacterial resistance 肠球菌属是人体肠道内正常菌群的一部分，为条件致病菌，可引起菌血症、心内膜炎、泌尿系感染和呼吸道严重感染。败血症和菌血症是临床上严重的感染性疾病，致死率高。研究血培养中肠球菌属细菌的分离率和耐药情况，对指导临床用药和正确诊治患者具有重要意义。现将我院2003～2007年的血培养肠球菌的数据报告如下。 1 材料和方法 1.1 标本来源 我院2003年1月～2007年12月住院患者送检血培养标本。 1.2 仪器和材料 BioMerieux公司的BacT/ALERT 120全自动血培养仪及其配套的血培养瓶；美国DADE Behring公司MicroScan Walkaway40全自动细菌鉴定仪及其配套阳性药敏组合板PC12；BD公司的Phoenix全自动微生物分析仪及其配套阳性药敏组合板。 选用的抗菌药物有万古霉素、青霉素、红霉