CAJ | 학술논문

目的：了解儿童感染肠球菌的临床分布、耐药表型和耐药基因的携带情况，为临床合理用药、控制院内感染及流行病学调查提供依据。方法收集西安市儿童医院2014年2月至2015年1月分离的肠球菌180株，用K-B法检测12种抗菌药物的耐药情况，运用多重PCR检测aac(6')-Ie-aph9(2')-Ia、aph(2')-Ib、aph(2')-Ic、aph (2')-Id、erm(B)、mef(A)、tet(M)、tet(L)等耐药基因。结果在180株临床分离株中屎肠球菌118株，粪肠球菌46株，其他肠球菌16株；其中分离自尿液的最多，占34.4%。药敏结果显示屎肠球菌对红霉素和四环素的耐药率分别为84.7%和67.8%，高浓度庆大霉素耐药(HLGR)菌株占83.0%；粪肠球菌对红霉素和四环素的耐药率为82.6%和82.6%，HLGR菌株占73.9%；未发现利奈唑胺和万古霉素耐药菌株。140株HLGR肠球菌中aac(6')-Ie-aph (2')-Ia检出率为92.8%，aph(2')-Ib、aph(2')-Ic、aph(2')-Id均为阴性。150株红霉素耐药菌株中erm(B)基因的检出率为66.6%，未检测到mef(A)基因。126株四环素耐药菌株中，tet(M)和tet(L)的检出率分别为98.4%和80.9%。结论儿童肠球菌感染主要由屎肠球菌和粪肠球菌引起，且以尿路感染最为常见；多重耐药情况严重，耐药性由多基因支配，HLGR为医院感染的重要耐药菌，主要通过aac(6')-Ie-aph(2')-Ia基因介导；红霉素的耐药性主要通过erm(B)基因介导；四环素的耐药基因以tet(M)和tet(L)多见。
목적：료해인동감염장구균적림상분포、내약표형화내약기인적휴대정황，위림상합리용약、공제원내감염급류행병학조사제공의거。방법수집서안시인동의원2014년2월지2015년1월분리적장구균180주，용K-B법검측12충항균약물적내약정황，운용다중PCR검측aac(6')-Ie-aph9(2')-Ia、aph(2')-Ib、aph(2')-Ic、aph (2')-Id、erm(B)、mef(A)、tet(M)、tet(L)등내약기인。결과재180주림상분리주중시장구균118주，분장구균46주，기타장구균16주；기중분리자뇨액적최다，점34.4%。약민결과현시시장구균대홍매소화사배소적내약솔분별위84.7%화67.8%，고농도경대매소내약(HLGR)균주점83.0%；분장구균대홍매소화사배소적내약솔위82.6%화82.6%，HLGR균주점73.9%；미발현리내서알화만고매소내약균주。140주HLGR장구균중aac(6')-Ie-aph (2')-Ia검출솔위92.8%，aph(2')-Ib、aph(2')-Ic、aph(2')-Id균위음성。150주홍매소내약균주중erm(B)기인적검출솔위66.6%，미검측도mef(A)기인。126주사배소내약균주중，tet(M)화tet(L)적검출솔분별위98.4%화80.9%。결론인동장구균감염주요유시장구균화분장구균인기，차이뇨로감염최위상견；다중내약정황엄중，내약성유다기인지배，HLGR위의원감염적중요내약균，주요통과aac(6')-Ie-aph(2')-Ia기인개도；홍매소적내약성주요통과erm(B)기인개도；사배소적내약기인이tet(M)화tet(L)다견。
Objective To investigate the clinical epidemiological trend and antibiotic resistant pattern of En-terococci isolated from infected children in order to guide the rational use of antibiotics and effective surveillance of nosocomial infections. Methods One hundred and eighty strains of Enterococci isolated from infected children in Xi'an Children's Hospital from February 2014 to January 2015 were collected and analyzed for epidemiological distri-bution and antibiotic susceptibility profile by K-B Method. Multiplex polymerase chain reaction (PCR) was used to de-tect the resistance genes for gentamycin [aac(6')-Ie-aph9(2' )-Ia, aph(2' )-Ib, aph(2' )-Ic, aph(2' )-Id], erythromycin [erm (B), mef(A)], tetracycline [tet(M), tet(L)]. Results Among the 180 isolates, which were mainly from urine (34.4%), there were 118 strains of Enterococcus faecium, 46 strains of E. faecalis and 16 strains of Enterococci spp (8.9%). Antibi-otic susceptibility of Enterococci against 12 antibiotics was determined by K-B method. High-level gentamycin resis-tance (HLGR) was present in 83.0%of E. faecium and 73.9%of E. faecalis isolates. Resistance to erythromycin and tetracycline was highly prevalent in E. faecium (84.7%and 67.8%, respectively) and E. faecalis (82.7%and 82.6%, re-spectively). Among the 140 HLGR isolates, the most prevalent resistant determinant was aac(6')-Ie-aph(2' )-Ia (92.9%), while none of the isolates harbored aph(2' )-Ib, aph(2' )-Ic or aph(2' )-Id. The erm(B) gene was responsible for erythromycin resistance in 66.6% of the erythromycin resistant enterococcal isolates, while other erythromycin resistant genes were not detected. The tet(M) and tet(L) genes were successfully amplified from 98.4%and 80.9%of tetracycline resistant isolates, respectively. There was no linezolid and vancomycin resistance. Conclusion Entero-cocci are important nosocomial pathogens with E. faecium and E. faecalis species most commonly isolated from clini-cal specimens in children. Urinary tract infection is the most common infection of Enterococcus for children. HLGR has become the important antibiotic resistance bacteria, which results in nosocomial infection, and the aac(6')-Ie-aph (2")-Ia gene is the main aminoglycoside-modifying enzyme gene which causes HLGR. erm(B) is the most prevalent genotype in the erythromycin resistant isolates, while harbouring tet(M) and tet(L) is the cause of tetracycline resis-tance.