2015年重庆市粪肠球菌和屎肠球菌耐药性监测结果分析

目的 统计分析2015年重庆市细菌耐药监测网成员单位提交的粪肠球菌和屎肠球菌耐药性监测数据,为该市有效应用抗菌药物提供依据和参考.方法 各成员单位根据全国细菌耐药监测网技术方案要求,对目标细菌进行鉴定和药敏试验,并依据美国临床和实验室标准化协会(CLSI)2015版标准进行结果判读,使用WHONET5.6软件对药敏数据进行统计分析,耐药性差异采用SPSS21.0软件进行分析.结果 共分离到非重复粪肠球菌和屎肠球菌分别为1 811株和1 601株,共占所有阳性菌株的13.1%,两者对万古霉素的耐药性分别为0.5%和1.8%,对利奈唑胺的耐药率分别为2.5%和0.5%,均未发现对替加环素耐药的菌株.粪肠球菌对奎奴普丁/达福普汀的耐药性最高,为90.1%,对四环素的耐药率也高达78.8%,对高浓度庆大霉素的耐药率为43.0%,对青霉素、氨苄西林、呋喃妥因的耐药率均低于7.0%.除奎奴普丁/达福普汀和四环素外,屎肠球菌对其他药物的耐药率高于粪肠球菌(P<0.05).儿童和成人患者,以及重症监护病房(ICU)和非ICU患者分离株对部分药物的耐药率比较差异有统计学意义(P<0.05).结论 该市肠球菌感染主要病原菌是屎肠球菌和粪肠球菌,两者耐药性不同.做好耐药性监测有助于指导临床医生规范、有效使用抗菌药物.     

临床分离肠球菌耐药性和耐药基因分布及其相关性研究

目的:研究临床分离肠球菌的耐药性、耐药基因分布及其相关性.方法:采用Vitek2 compact全自动细菌鉴定及药敏分析系统进行临床分离肠球菌的鉴定和药敏试验;提取细菌基因组DNA,通过PCR法检测14种肠球菌耐药相关基因;采用SPSS25.0软件对肠球菌耐药性和耐药基因相关性进行统计学分析.结果:临床分离的89株肠球...     

肠球菌属在血液标本的分布及耐药性分析

目的探讨肠球菌属在血液标本中的分布与耐药性变迁,为指导临床合理用药,控制感染提供依据。方法对该院2007～2009年临床送检血液标本进行常规培养、鉴定和药敏试验,并用WHONET 5.4软件统计分析这3年间肠球菌临床分离株血液标本、病区中的分布与耐药性的变迁情况。结果共检出肠球菌属细菌62株,菌株以粪肠球菌为主,共33株(53.2%),其次为屎肠球菌25株(40.3%);肠球菌属对红霉素、四环素和青霉素G有较高耐药性,无耐万古霉素的菌株。结论 3年来在细菌种类和耐药方面肠球菌属均发生了较大变化,不同种类的细菌其耐药性差异很大,临床抗感染治疗应以分离菌株的体外抗生素敏感性为依据,合理选用抗生素,以提高其疗效。     

某院2009～2011年肠球菌属细菌的耐药性分析

目的探讨肠球菌属细菌的耐药性特征。方法对该院住院及门诊患者送检标本分离出的肠球菌进行药物敏感性试验,以探讨肠球菌的耐药性特点。结果对青霉素类、喹诺酮类、呋喃妥因、红霉素、高浓度庆大霉素以及利福平的耐药性,屎肠球菌明显高于粪肠球菌。对四环素类抗菌药物、氯霉素以及高浓度链霉素的耐药性,屎肠球菌明显低于粪肠球菌。万古霉素以及替考拉宁对肠球菌属细胞具有很高的敏感性。结论临床上需要对常见的病原菌进行耐药性研究,对肠球菌的耐药性进行动态监测可以对临床治疗起到重要的指导作用。     

220株肠球菌的分布及耐药性研究

目的 调查重庆市某医院肠球菌属细菌的临床分布及对常见抗菌药物的耐药性.方法 采集临床各科送检的标本,进行肠球菌细菌的分离和培养,使用Vitek-Compact系统对肠球菌细菌进行鉴定,采用仪器法检测抗菌药物的MIC值,并根据CLSI的指导原则判定细菌的耐药性.结果 共分离到220株非重复肠球菌,最常见菌种为粪肠球菌95株(43.2%)、屎肠球菌84株(38.2%)和鹑鸡肠球菌32株(14.5%).药敏试验结果表明,屎肠球菌的总体耐药率高于粪肠球菌;肠球菌属对四环素、红霉素、庆大霉素的耐药率较高,对万古霉素、利奈唑胺保持高度敏感性.结论 肠球菌感染以屎肠球菌和粪肠球菌为主,可引起多部位感染,且对临床常用抗菌药物严重耐药.     

焦作某医院中段尿分离粪肠球菌与屎肠球菌耐药性分析

目的分析326株泌尿系感染粪肠球菌与屎肠球菌的耐药性,为临床合理使用抗生素提供依据。方法对医院2014年1月至2017年12月门诊及住院送检的中段尿培养分离的粪肠球菌与屎肠球菌进行回顾性分析,采用珠海黑马微生物鉴定产品进行细菌鉴定及药敏试验,使用WHONET 5.4软件对数据进行统计分析。结果 326株粪肠球菌与屎肠球菌,粪肠球菌占57.7%,屎肠球菌占42.3%,粪肠球菌分离率高于屎肠球菌;屎肠球菌对氨苄西林(92.8%)、红霉素(93.5%)、环丙沙星(88.4%)、高浓度庆大霉素(76.1%)、青霉素(93.5%)、左氧氟沙星(81.9%)、利福平(77.5%)表现出高度耐药率,粪肠球菌对红霉素(82.4%)、四环素(86.2%)、高浓度庆大霉素(68.6%)表现出高度耐药率,粪肠球菌与屎肠球菌分别检出利奈唑胺耐药1.1%、2.9%,未检出万古霉素与替考拉宁耐药菌株。结论粪肠球菌与屎肠球菌对抗菌药物耐药性差别较大,临床需依据细菌鉴定及药物结果合理使用抗生素,检出的利奈唑胺耐药粪肠球菌与屎肠球菌,应引起临床医生与感控人员的注意,加强细菌耐药性检测,从而减少耐药株的产生,防止细菌耐药性的增加。     

420株临床分离肠球菌属细菌的耐药性变迁

目的 探讨肠球菌属细菌临床分离情况与耐药性变迁,为指导临床合理用药,控制感染提供依据。方法 对湖南省张家界市人民医院2008年1月至2013年6月临床送检标本进行常规细菌培养、鉴定和药敏试验,并用WHONET5.6软件统计分析这6年间肠球菌属细菌临床分离株在各标本、科室中的分布与耐药性的变迁情况。结果 2008~2013年6月共分离出肠球菌属细菌420株,其中屎肠球菌288株,占68.6%,粪肠球菌128株,占30.5%,鹑鸡肠球菌3株,占0.7%,铅黄肠球菌1株,占0.2%;肠球菌属细菌在各标本中的分布以尿液为主,占60.5%;其次为伤口分泌物,占20.0%;血液,占13.6%。6年来肠球菌属细菌的菌种和耐药性均发生了较大变化,屎肠球菌所占比率每年基本保持在65%左右,粪肠球菌所占比率在35%左右。屎肠球菌对氨苄西林、青霉素以及呋喃妥因的耐药率明显高于粪肠球菌,对青霉素、四环素、呋喃妥因、高浓度的庆大霉素、高浓度的链霉素、环丙沙星、氨苄西林等抗菌药物的耐药率接近或超过70%。2008年发现2株、2009年1株,共3株屎肠球菌对万古霉素耐药;2008年发现1株、2009年5株、2010年7株,共13株粪肠球菌对万古霉素中介。结论 肠球菌属细菌耐药性较为严重,不同菌种耐药性有所差异。临床抗感染治疗应以分离菌株体外抗菌药物的敏感性为依据,合理选用抗菌药物,以提高疗效。     

某医院2009~2013年粪肠球菌和屎肠球菌的耐药性监测

目的 了解2009~2013年该院临床分离粪肠球菌和屎肠球菌对各类抗菌药物的耐药性。方法 临床分离菌采用最低抑菌浓度法进行细菌的药敏试验,结果按临床实验室标准化协会2013年版的标准进行判断。结果 共分离得到非重复粪肠球菌819株,屎肠球菌726株,这两种菌株对利奈唑胺和万古霉素仍很敏感,耐药率均低于1.5%。粪肠球菌和屎肠球菌对万古霉素的耐药率分别为0.1%和1.5%。粪肠球菌对青霉素、氨苄西林和呋喃妥因的耐药率较低,分别为4.3%、1.6%和1.6%;屎肠球菌对青霉素和氨苄西林的耐药率都在87.0%以上,明显高于粪肠球菌。结论 该院的肠球菌感染中以粪肠球菌为主,屎肠球菌感染次之,二者的耐药性差异明显,持续监测其耐药情况有助于指导临床合理用药。     

胆汁标本肠球菌的分布及药敏分析

目的分析胆汁中肠球菌属各细菌的分布及其耐药性。方法收集肝胆科623例手术中或术后胆汁进行细菌培养及药敏试验。结果检出细菌426例，共488株。阳性率为68．4％，其中肠球菌150株，检出率为30．7％，略高于大肠埃希菌（148株）的检出率（30．3％）；混合感染2～3种细菌的胆汁标本60例，其中肠球菌与其它细菌混合感染的45例，占总混合感染的75％。药敏结果显示．粪肠球菌对青霉素G、氨卞西林及高浓度庆大霉素的耐药率明显低于屎肠球菌，粪肠球菌对奎奴普汀的耐药牢较高：粪肠球菌、屎肠球菌、鸟肠球菌对万古霉素未见耐药。结论肠球菌在胆汁中的检出率及其混合感染率较高．并对常用的抗生素均有不同程度的耐药性．但对万古雹素和替考拉宁具有高度的敏感性。     

肠球菌的分布及耐药性分析

目的 探究肠球菌的分布并分析其耐药性.方法 采用VITEK-32全自动微生物鉴定及药敏系统对所有菌株进行常规分离培养.细菌分离培养采用〈全国临床检验操作规程〉常规技术检测和API细菌鉴定条件鉴定.结果 255株肠球菌属五种,以粪肠球菌、屎肠球菌居多.主要分布于尿标本、胆汁标本、伤口分泌物标本;血液标本、痰液标本;粪肠球菌和屎肠球菌对左氧氟沙星的耐药率最高,其他肠球菌对四环素和红霉素的耐药率较高;肠球菌对万古霉素、氨芐西林、青霉素和呋喃妥因抗菌药物的耐药率较低.结论 研究肠球菌的分布及耐药性可以促进临床合理用药,避免发生院内感染.     

肠球菌对万古霉素药敏实验方法的探讨

目的 :用 4种药敏试验方法比较肠球菌对万古霉素药敏结果的可靠性。方法 :采用Vitek 32型GPB TG药敏卡、肉汤稀释法、K B纸片扩散法和琼脂筛选法进行球肠菌对万古霉素的药敏实验。结果 :Vitek药敏卡和肉汤稀释法的药敏结果无显著差异 (P >0 .0 5 ) ,K B法药敏结果与上述两种方法比较 ,有非常显著的差异 (P <0 .0 1)。结论 :肠球菌对万古霉素的药敏检测方法最好采用仪器法或肉汤稀释法 ,K B纸片扩散法度及耐药结果不可靠 ,琼脂筛选法检测对万古霉素低水平耐药的肠球菌最灵敏     

多重PCR检测万古霉素耐药的肠球菌

目的检测2005～2007年澳大利亚墨尔本地区万古霉素耐药的肠球菌基因。方法用多重PCR检测肠球菌4种耐药基因(vanA,vanB,vanC1和vanC2),鉴定4种肠球菌E.faecalis(粪肠球菌),E.faecium(屎肠球菌),E.gallinarum(母鸡肠球菌)和E.casseliflavus(产黄肠球菌)。结果vanA基因扩增阳性可见732bp条带;vanB基因为635bp条带;vanC1基因为822bp条带;vanC2/3基因为439bp条带。粪肠球菌基因扩增见941bpDNA条带,屎肠球菌为550bpDNA条带。3年回顾性研究中,最常见的万古霉素耐药基因是vanB型(84.9%),菌种是屎肠球菌(76.3%)。2007年还出现2株同时含有vanA和vanB耐药基因的屎肠球菌菌株。结论万古霉素耐药的肠球菌菌株逐年增多,多重PCR检测万古霉素耐药的肠球菌,简便迅速,有利于准确及时地发出报告。     

耐万古霉素肠球菌表型检测及基因分型

目的 研究对万古霉素耐药或中介的肠球菌株的表型和基因型，以了解本院耐万古霉素肠球菌（VRE）的流行状况，指导临床合理用药。方法 收集200株临床分离的肠球菌株，用琼脂筛选法筛选VRE，并分别用E test和多重PCR检测和分析对万古霉素耐药或中介肠球菌株的表型和基因型。结果 共检出10株对万古霉素耐药或中介的肠球菌株，其中5株为天然耐万古霉素肠球菌。基因型分析的结果为1株van A型，4株van C1型，3株van C2型，2株基因型不明。结论 已发现5株VRE（1株VAN A型），提示临床上须合理使用抗生素，以防止VRE等多重耐药细菌的爆发流行。     

The influence of antibiotic use on the occurrence of vancomycin-resistant enterococci

BACKGROUND: Several studies have documented the influence of antibiotic selective pressure, mainly from the use of glycopeptides, third-generation cephalosporins, quinolones and lincosamides, on the frequency of vancomycin-resistant enterococci (VRE) occurrence in hospitals. The aim of this study was to evaluate the relationship between VRE occurrence and antibiotic use in the Department of Hemato-Oncology of the Teaching Hospital in Olomouc (DHO), Czech Republic, over a 6-year period under standard and unchanged hygienic and epidemiological conditions. METHODS: During the period of 1998-2003, Enterococcus sp. strains and VRE were isolated by standard methods from clinical samples taken from DHO in-patients. The frequency of VRE occurrence was expressed as the number of isolated strains per 100 bed-days/year. DHO antibiotic consumption data were processed according to the anatomical therapeutic chemical (ATC)/defined daily dose (DDD) system valid in 2003 and expressed in defined daily dose per 100 bed-days (DDD/100 bed-days) for each year of the period. RESULTS: Since 1998, the occurrence of VRE decreased significantly (from 0.28 to 0.17 VRE/100 bed-days in 2001). Between 2001 and 2003, a significant (P < 0.05) increase from 0.17 to 0.38 was observed. The antibiotic use decreased from 205.2 in 1998 to 161.0 DDD/100 bed-days in 1999 and after an increase in 2001 (to 181.8 DDD/100 bed-days) it remained relatively stable. A significant decrease was observed in third-generation cephalosporins and quinolones (from 29.5 to 9.7 and from 42.2 to 30.2 DDD/100 bed-days respectively) between 1998 and 1999. In 2002-2003, the use of third-generation cephalosporins and glycopeptides increased substantially (from 10.1 to 13.9 and from 11.3 to 15.2 DDD/100 bed-days respectively). The Pearson correlation value was significantly positive (P < 0.05) for VRE occurrence and the use of glycopeptides and third-generation cephalosporins. CONCLUSIONS: While our study confirms the effect of use of glycopeptides and third-generation cephalosporins on occurrence of VRE, no influence of quinolones and lincosamides over the 6-year period was shown.     

In vitro efficacy of fosfomycin-based combinations against clinical vancomycin-resistant Enterococcus isolates

Vancomycin-resistant (VR) enterococci (VRE) are increasingly important nosocomial pathogens, commonly causing catheter-related urinary tract infections or vascular catheter-related bloodstream infections. In this study, 10 Enterococcus faecium and 9 Enterococcus faecalis different pulsed-field gel electrophoresis genome-type VR clinical isolates were detected. The potential role of fosfomycin-based combination regimens for biofilm-related VRE infection is in vitro evaluated. Anti-VRE activities of fosfomycin, ampicillin, linezolid, minocycline, rifampicin, tigecycline, teicoplanin, vancomycin alone, or fosfomycin-based combinations were studied by time-kill method and a biofilm model. Of the fosfomycin-based combinations, a synergistic effect was particularly noted for teicoplanin against 89% of the VR E. faecalis isolates. In a biofilm model, only linezolid alone was able to reduce the bacterial loads, and the use of fosfomycin-based combinations, excluding rifampicin (40%), failed to enhance antibacterial activity against VR E. faecium. For E. faecalis, an inhibitory effect was evident using ampicillin alone or fosfomycin plus rifampicin (100%), tigecycline (56%), or teicoplanin (44%). However, an antagonistic effect was found for ampicillin plus fosfomycin against 2 of 3 of the VR E. faecalis isolates. The antibacterial activities of the drugs tested against VRE in vitro varied by species. Ampicillin exhibited potential activity against planktonic- and biofilm-embedded VR E. faecalis. Fosfomycin-based combinations may have enhanced antibacterial effects against VRE even in the biofilm model, and this observation warrants further clinical studies.     

Mechanisms of antibiotic resistance in enterococci

Multidrug-resistant (MDR) enterococci are important nosocomial pathogens and a growing clinical challenge. These organisms have developed resistance to virtually all antimicrobials currently used in clinical practice using a diverse number of genetic strategies. Due to this ability to recruit antibiotic resistance determinants, MDR enterococci display a wide repertoire of antibiotic resistance mechanisms including modification of drug targets, inactivation of therapeutic agents, overexpression of efflux pumps and a sophisticated cell envelope adaptive response that promotes survival in the human host and the nosocomial environment. MDR enterococci are well adapted to survive in the gastrointestinal tract and can become the dominant flora under antibiotic pressure, predisposing the severely ill and immunocompromised patient to invasive infections. A thorough understanding of the mechanisms underlying antibiotic resistance in enterococci is the first step for devising strategies to control the spread of these organisms and potentially establish novel therapeutic approaches.     

452例革兰阳性葡萄球菌耐药分析

目的了解葡萄球菌最新分离情况及耐药分析。方法采用K-B法检测我院临床分离的革兰阳性葡萄球菌对抗生素的敏感性。按照美国国家临床实验室标准委员会（CLSI/NCCLS）2005的标准进行分析。结果检测有菌阳性标本1419例。革兰阳性葡萄球菌检出452例,检出率为31.9%。其中,凝固酶阳性金黄色葡萄球菌（MSSA）4.3%,耐甲氧西林凝固酶阳性金黄色葡萄球菌（MRSA）检出率为17.5%,凝固酶阴性金黄色葡萄球菌（MSSCoN）9.5%,耐甲氧西林凝固酶阴性金黄色葡萄球菌（MRSCoN）检出率为39.9%。粪肠球菌检出204例,检出率为14.4%。屎肠球菌检出204例,检出率为14.4%。耐甲氧西林凝固酶阴性金黄色葡萄球菌（MRSCoN）感染明显上升,同时也是检出率最高的。粪肠球菌和屎肠球菌检出率相当,但屎肠球菌耐药性明显高于粪肠球菌。结论葡萄球菌感染在临床非常普遍,MRSA和MRSCoN也出现了严重的耐药性。     

Short course of linezolid treatment for vancomycin-resistant Enterococcus faecium meningitis

Enterococci might be one of the meningitis pathogens, but meningitis is rarely caused by vancomycin-resistant enterococci. In this report, we present a 69-year-old man who had the underlying chronic obstructive pulmonary disease with long-term steroid treatment suffered from a meningitis episode after hospitalisation for the urinary tract infection. The cerebrospinal fluid culture of the patient grew Enterococcus faecium which was resistant to vancomycin. A vancomycin-resistant E. faecium was also isolated from the rectal swab of the patient. These two E. faecium isolates were found to harbour the vanA gene and to be identical by pulsed field gel electrophoresis typing. The patient was treated successfully with intravenous linezolid, 600 mg every 12 h for 2 weeks. This was the first case of meningitis caused by vancomycin-resistant E. faecium in Taiwan.     

A rapid antimicrobial susceptibility test based on chemiluminescence assay and its application to screening of genotypes in vancomycin-resistant enterococci

Minimum inhibitory concentrations (MICs) of vancomycin (VCM) and teicoplanin (TEIC) were measured using a novel susceptibility test based on the chemiluminescence assay (CA) method (Rapid-Lumi Eiken; Eiken Chemicals, Tokyo, Japan) against 33 strains in total: 7, 5, and 10 strains of which are VCM-resistant enterococci (VRE) with vanA, vanB, and vanC genes, respectively, and the other 11 strains are vancomycin-susceptible enterococci (VSE). The results were in good accordance with the values determined by the standard broth dilution method approved by the National Committee for Clinical Laboratory Standards (NCCLS): i.e., 88% (29/33) of consistency for VCM and 97% (32/33) for TEIC, respectively. In addition, genotypes in VRE strains (vanA, vanB, vanC-1, and vanC-2/3 genes) were properly estimated from the results of the CA method and the NCCLS interpretive categories, even though the incubation time was very short (2–4h). In conclusion, it was found that the new method is reliable and rapid to detect VRE strains in clinical laboratories.     

Vancomycin-resistant enterococci (VRE) outbreak at a university hospital in Kitakyushu,Japan: case-control studies

At a university hospital in Japan, a total of 15 patients (14 adults and 1 newborn baby) with vancomycinresistant enterococci (VRE) infection or colonization (inf/col) were identified via routine clinical examinations and two nonroutine examinations from January to April 2007. Two case-control studies were conducted to identify the factors related to VRE inf/col. In study 1, the patients with VRE inf/col from ward A (n = 8) were compared with all of the patients without VRE isolates in the same ward, i.e., the controls (n = 26). In study 2, all adult patients with VRE inf/col throughout the hospital (n = 14) were compared with controls randomly selected from among all patients without VRE isolates (n = 45). All the subject cases were found to be infected or colonized with Enterococcus faecium, vanB. All but two of the isolated strains were completely identical according to pulsed field gel electrophoresis. Univariate analysis in study 2 showed several factors, including the isolation of methicillin-resistant Staphylococcus aureus (MRSA) (odds ratio [OR], 8.6; 95% confidence interval [CI], 1.3–53.7) and the use of antibiotics other than anti-MRSA drugs (OR, 33.0; 95% CI, 1.8–587.6) to be risk factors for VRE inf/col. Multivariate logistic regression analysis in study 2 demonstrated associations with VRE inf/col in the use of an ultrasound nebulizer (OR, 5.9; 95% CI, 1.5–22.8) and extended bed rest (OR, 3.8; 95% CI, 1.02–24.5). Although severe infection with VRE did not occur, to avoid the spread of VRE in hospital wards, further staff education should be implemented in regard to the usual standard and contact precautions, and the appropriate selection of antibiotics.