CAJ | 학술논문

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。
목적：탐토장구균속세균림상분리정황여내약성변천，위지도림상합리용약，공제감염제공의거。방법대호남성장가계시인민의원2008년1월지2013년6월림상송검표본진행상규세균배양、감정화약민시험，병용 WHONET5．6연건통계분석저6년간장구균속세균림상분리주재각표본、과실중적분포여내약성적변천정황。결과2008～2013년6월공분리출장구균속세균420주，기중시장구균288주，점68．6％，분장구균128주，점30．5％，순계장구균3주，점0．7％，연황장구균1주，점0．2％；장구균속세균재각표본중적분포이뇨액위주，점60．5％；기차위상구분비물，점20．0％；혈액，점13．6％。6년래장구균속세균적균충화내약성균발생료교대변화，시장구균소점비솔매년기본보지재65％좌우，분장구균소점비솔재35％좌우。시장구균대안변서림、청매소이급부남타인적내약솔명현고우분장구균，대청매소、사배소、부남타인、고농도적경대매소、고농도적련매소、배병사성、안변서림등항균약물적내약솔접근혹초과70％。2008년발현2주、2009년1주，공3주시장구균대만고매소내약；2008년발현1주、2009년5주、2010년7주，공13주분장구균대만고매소중개。결론장구균속세균내약성교위엄중，불동균충내약성유소차이。림상항감염치료응이분리균주체외항균약물적민감성위의거，합리선용항균약물，이제고료효。
Objective To study the clinical isolation situation of Enterococcus bacteria and the drug resistance change to provide the basis for guiding clinical rational drug use and controlling infection.Methods The clinical specimens in our hospital from Janu-ary 2008 to June 2013 were performed the routine bacterial culture,identification and drug sensitivity test.The WHONET 5.6 soft-ware was used to analyze the distribution of the clinical Enterococcus bacteria l isolates in various samples and the departments and the drug resistance change during this period.Results Total 420 strains of Enterococcus bacteria were isolated during this period, including 288 strains of E.faecium(68.6%),128 strains of E.faecalis(30.5%),3 strains of E.gallinarum(0.7%)and 1 strain of E.casseliflavus(0.2%).The Enterococcus bacteria isolates were mainly distributed in urine(60.5%),wound secretion(20.0%) and blood(13.6%).The large changes occurred in the strains and drug-resistance of isolated Enterococcus bacteria during this peri-od.The proportion of E.faecium maintained about 65% every year.The proportion of E.faecalis was about 35%.The resistance rate of E.faecium to ampicillin,penicillin and nitrofurantoin was significantly higher than that of E.faecalis .Its resistance rates to penicillin,tetracycline,nitrofurantoin,high concentration gentamycin,high concentration streptomycin,ciprofloxacin and ampicillin were close to or over 70%.Total 3 strains of vancomycin-resistant E.faecium were isolated,including 2 strains in 2008 and 1 strain in 2009.Total 13 strains of vancomycin-intermediate E.faecalis were isolated,including 1 strain in 2008,5 strains in 2009 and 7 strains in 2010.Conclusion The drug resistance of Enterococcus bacteria is very serious and the drug resistance of different strains is different.The clinical anti-infection should rationally select the antibacterial drugs for increasing the curative effects according to the in vitro susceptibility of the isolated strains to the bacterial drugs.