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2009年1月－2017年6月我院肠球菌的临床分布及耐药性分析
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| 篇名： | 2009年1月－2017年6月我院肠球菌的临床分布及耐药性分析 |
| TITLE： | |
| 摘要： | 目的：为临床治疗及控制医院感染提供参考。方法：收集2009年1月－2017年6月我院住院患者临床分离的肠球菌病原学资料，回顾性分析其对常用抗菌药物的耐药情况及感染相关危险因素。结果：共检出肠球菌6 252株，其中粪肠球菌1 994株、屎肠球菌3 575株；主要分离自尿液（2 009株）、引流液（1 538株）、胆汁（1 168株）、伤口分泌物（561株）、血液（493株）；检出率由2009年的9.4％上升至2017年的13.4％。粪肠球菌对氨苄西林、青霉素、万古霉素耐药率呈波动下降趋势，且对万古霉素、利奈唑胺、替考拉宁和替加环素的耐药率较低；对环丙沙星、莫西沙星、左氧氟沙星耐药率波动下降至2014年，后于2015年开始呈波动上升趋势。屎肠球菌对利奈唑胺耐药率从2009 年的1.9％下降至2017年6月的0.2％；对万古霉素、替考拉宁耐药率持续波动，但仍处于较低水平；对四环素耐药率呈下降趋势，而对高浓度庆大霉素耐药率呈上升趋势。有51例患者检出耐万古霉素屎肠球菌（43株）和耐万古霉素粪肠球菌（8株）。耐万古霉素屎肠球菌对利奈唑胺、替加环素、替考拉宁耐药率分别为23.3％、0、35.3％，耐万古霉素粪肠球菌对利奈唑胺、替加环素、替考拉宁的耐药率均为0。Pearson相关性分析发现，患者入住重症加强护理病房天数（r＝0.225，P＜0.01）、气管切开或插管率（r＝0.314，P＜0.01）、抗菌药物使用天数（r＝0.347，P＜0.01）、抗菌药物使用种类（r＝0.226，P＜0.01）、使用了糖皮质激素（r＝0.190，P＜0.01）、碳青霉烯类抗菌药物使用天数（r＝0.173，P＜0.05）均与耐万古霉素粪肠球菌和耐万古霉素屎肠球菌感染率呈正相关。结论：我院的肠球菌检出率呈波动上升趋势，以粪肠球菌和屎肠球菌为主，主要来源于尿液和引流液。粪肠球菌对大部分抗菌药物的耐药率呈下降趋势；屎肠球菌对高浓度庆大霉素的耐药率呈上升趋势，对利奈唑胺、四环素的耐药率呈下降趋势。临床用药时应根据患者情况和药敏试验结果选择合适抗菌药物。 |
| ABSTRACT： | OBJECTIVE： To provide reference for hospital infection treatment and control. METHODS： The etiological data of Enterococcus isolated from clinical specimens were collected from our hospital during Jan. 2009-Jun. 2017. The drug resistance of commonly used antibiotics and infection related risk factors were analyzed retrospectively. RESULTS： A total of 6 252 isolates of Enterococcus were isolated， of which there were 1 994 strains of E. faecalis and 3 575 strains of E. faecium. The bacteria were mainly isolated from urine （2 009 strains）， drainage liquids （1 538 strains）， bile （1 168 strains）， wound secretions （561 strains）， blood （493 strains）. The detection rate increased 9.4％ in 2009 to 13.4％ in 2017. Resistance rate of E. faecalis to ampicillin， penicillin and vancomycin showed a wavelike decrease， and E. faecalis showed low resistance rate to vancomycin， teicoplanin， linezolid and tigecycline. Resistance rate of E. faecalis to ciprofloxacin， moxifloxacin and levofloxacin decreased wavily to 2014 but showed a fluctuating upward trend since 2015. Resistance rate of E. faecium to linezolid decreased from 1.9％ in 2009 to 0.2％ in Jun. 2017； resistance rate of E. faecium to vancomycin and teicoplanin continues to fluctuate， but it is still at a low level； resistance rate of E. faecium to tetracycline decreased， but that to high concentration gentamicin increased. There were 43 strains of vancomycin-resistant E. faecium and 8 trains of vancomycin-resistant E. faecalis detected in 51 patients. Resistant rates of vancomycin-resistant E. faecium to linezolid， tigecycline and teicoplanin were 23.3％， 0， 35.3％， respectively. Resistant rates of vancomycin-resistant E. faecalis to linezolid， tigecycline and teicoplanin were 0. Pearson relationship analysis showed that days in ICU （r＝0.225，P＜0.01）， tracheotomy or intubation （r＝0.314，P＜0.01）， days of antibiotic use （r＝0.347，P＜0.01）， types of antibacterial drugs （r＝0.226，P＜0.01）， use of glucocorticoids （r＝0.190，P＜0.01）， and days of carbapenems use （r＝0.173，P＜0.05） were positively correlated with vancomycin-resistant E. faecium infection rate and vancomycin-resistant E. faecalis infection rate. CONCLUSIONS： The detection rate of Enterococcus in our hospital is fluctuating upward. E. faecalis and E. faecium were the main types， mainly from urine and drainage fluids. The resistance rate of Enterococcus most of antibiotics shows a downward trend. The resistance rate of E. faecium to high concentration gentamycin is on the rise， while that of E. faecium to linezolid and tetracycline is decreased. The appropriate antibiotics should be selected according to the patient’s condition and drug susceptibility results. |
| 期刊： | 2018年第29卷第10期 |
| 作者： | 郑巧伟，任晓东，秦涛，罗赛赛，封卫毅，魏友霞 |
| AUTHORS： | ZHENG Qiaowei，REN Xiaodong，QIN Tao，LUO Saisai，FENG Weiyi，WEI Youxia |
| 关键字： | 肠球菌；抗菌药物；耐药性；临床分布；合理用药 |
| KEYWORDS： | Enterococcus； Antibiotics； Drug resistance； Clinical distribution； Rational drug use |
| 阅读数： | 277 次 |
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