2011-2016年粪肠球菌和屎肠球菌耐药趋势分析
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摘要
目的探讨临床来源的粪肠球菌和屎肠球菌2011-2016年6年间耐药趋势变化,为控制肠球菌感染及抗菌药物的选择提供参考。方法收集2011年1月-2016年12月医院门诊及住院患者送检标本中分离出的160株粪肠球菌与210株屎肠球菌,回顾性分析药物敏感试验结果。结果 6年间,粪肠球菌及屎肠球菌对万古霉素、替考拉宁、替加环素无耐药菌株出现;粪肠球菌对阿莫西林/克拉维酸、利奈唑胺、氨苄西林/舒巴坦、氨苄西林、哌拉西林/他唑巴坦的6年整体耐药率较低,对亚胺培南、呋喃妥因、青霉素G的6年整体耐药率在8.00%～25.00%之间,对氯霉素、环丙沙星、左氧氟沙星的6年整体耐药率为15.00%～50.00%之间,屎肠球菌对奎奴普丁/达福普汀6年整体耐药率<10%,2011-2016年连续分离出的粪肠球菌、屎肠球菌对临床抗菌药物的耐药率差异无统计学意义。屎肠球菌对阿莫西林/克拉维酸、氨苄西林、氨苄西林/舒巴坦、环丙沙星、红霉素、亚胺培南、左氧氟沙星、呋喃妥因、青霉素G、哌拉西林/他唑巴坦、利福平、利奈唑胺的2011-2016年整体耐药率高于粪肠球菌(P<0.001);屎肠球菌对氯霉素、高浓度庆大霉素、四环素、奎奴普丁/达福普汀的2011-2016年整体耐药率低于粪肠球菌(P<0.05)。结论临床分离的粪肠球菌和屎肠球菌对临床常用抗菌药物普遍表现为多药耐药,同一菌种对同一抗菌药物近6年的耐药率变化趋势并不明显,万古霉素、替考拉宁、替加环素仍是敏感药物。
OBJECTIVE To explore the trends in drug resistance of Enterococcus faecalis and Enterococcus faecium from clinical sources during 2011-2016,so as to provide reference for control of enterococcal infection and selection of antimicrobial agents.METHODS The total of 160 strains of E faecalis and 210 strains of E faeciumis isolated from specimens of outpatients and inpatients in 2011-2016 were collected.The results of drug sensitivity test were retrospectively analyzed.RESULTS No vancomycin,teicoplanin and tigecycline-resistant strains of E faecalis and E faecium were found during the period of 6 years.The overall drug resistance rate of E faecalis to amoxicillin/clavic acid,lineazolamide,ampicillin/shubatan,ampicillin,and piperacillin/tazobactam in the 6 years was 10.00%.The overall drug resistance rate of E faecalis to imipenan,nitrofurantoin and penicillin G in the 6 years was in the range of 8.00%-25.00%.The overall drug resistance rate of E faecalis to chloramphenicol,ciprofloxacin and levofloxacin in the 6 years was in the range of 15.00%～50.00%.The overall drug resistance rate of E faecium to quinupristin/dalfopristin was below 10.00%.There was no significant change in the drug resistance rate of E faecalis and E faeciumcontinuously isolated during 2011-2016 to clinical antimicrobial agents.The overall resistance rates of E faeciumto amoxicillin/clavic-acid,ampicillin,ampicillin/sulbactam,ciprofloxacin,erythromycin,imipenem,levofloxacin,nitrofurantoin,penicillin G,piperacillin/tazobartan,rifampicin and linezolid in 2011-2016 were higher than those of E faecalis(P<0.001).The overall resistance rates of E faecium to chloramphenicol,high concentrations of gentamicin,tetracycline and quinupristin/dalfopristin in 2011-2016 were significantly lower than those of E faecalis(P<0.05).CONCLUSION The clinically isolated E faecalis and E faecium showed multi-drug resistance against commonly used antibacterial drugs.The changing trend of drug resistance of the same strain to the same antimicrobial drug in the past 6 years is not obvious,with vancomycin,teicoplanin and tigecycline remaining as the sensitive drugs.
OBJECTIVE To explore the trends in drug resistance of Enterococcus faecalis and Enterococcus faecium from clinical sources during 2011-2016,so as to provide reference for control of enterococcal infection and selection of antimicrobial agents.METHODS The total of 160 strains of E faecalis and 210 strains of E faeciumis isolated from specimens of outpatients and inpatients in 2011-2016 were collected.The results of drug sensitivity test were retrospectively analyzed.RESULTS No vancomycin,teicoplanin and tigecycline-resistant strains of E faecalis and E faecium were found during the period of 6 years.The overall drug resistance rate of E faecalis to amoxicillin/clavic acid,lineazolamide,ampicillin/shubatan,ampicillin,and piperacillin/tazobactam in the 6 years was 10.00%.The overall drug resistance rate of E faecalis to imipenan,nitrofurantoin and penicillin G in the 6 years was in the range of 8.00%-25.00%.The overall drug resistance rate of E faecalis to chloramphenicol,ciprofloxacin and levofloxacin in the 6 years was in the range of 15.00%～50.00%.The overall drug resistance rate of E faecium to quinupristin/dalfopristin was below 10.00%.There was no significant change in the drug resistance rate of E faecalis and E faeciumcontinuously isolated during 2011-2016 to clinical antimicrobial agents.The overall resistance rates of E faeciumto amoxicillin/clavic-acid,ampicillin,ampicillin/sulbactam,ciprofloxacin,erythromycin,imipenem,levofloxacin,nitrofurantoin,penicillin G,piperacillin/tazobartan,rifampicin and linezolid in 2011-2016 were higher than those of E faecalis(P<0.001).The overall resistance rates of E faecium to chloramphenicol,high concentrations of gentamicin,tetracycline and quinupristin/dalfopristin in 2011-2016 were significantly lower than those of E faecalis(P<0.05).CONCLUSION The clinically isolated E faecalis and E faecium showed multi-drug resistance against commonly used antibacterial drugs.The changing trend of drug resistance of the same strain to the same antimicrobial drug in the past 6 years is not obvious,with vancomycin,teicoplanin and tigecycline remaining as the sensitive drugs.
引文
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[5]马孝煜,蒲彰雅,姚伟明,等.耐利奈唑胺粪肠球菌感染的危险因素分析[J].微生物与感染,2017,12(4):217-221.
[6]陈亮,李真,刘颖,等.肠球菌血流感染的临床特征和预后因素分析[J].中华医院感染学杂志,2017,27(9):1944-1947.
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[9] Dale JL,Cagnazzo J,Phan CQ,et al.Multiple roles for Enterococcus faecalis glycosyltransferases in biofilm-associated antibiotic resistance,cell envelope integrity,and conjugative transfer[J].Antimicrob Agents Chemother,2015,59(7):4094-4105.
[10] Faron ML,Ledeboer NA,Buchan BW.Resistance mechanisms,epidemiology,and approaches to screening for vancomycin-resistant Enterococcus in the health care setting[J].J Clin Microbiol,2016,54(10):2436-2447.
[11]张莹,龚瑞娥,刘珍如,等.677例多药耐药菌医院感染病例分析[J].中华医院感染学杂志,2017,27(18):4118-4122.
[12]李万翔,刘秘,吕火烊.肠球菌耐万古霉素机制研究进展[J].中国微生态学杂志,2014,26(5):600-603.
[13] Britt NS,Potter EM,Patel N,et al.Comparison of the effectiveness and safety of linezolid and daptomycin in vancomycin-resistant enterococcal bloodstream infection:a national cohort study of Veterans Affairs patients[J].Clin Infect Dis,2015,61(6):871-878.
[14] Cavaco LM,Bernal JF,Zankari E,et al.Detection of linezolid resistance due to the optrA gene in Enterococcus faecalis from poultry meat from the American continent(Colombia)[J].J Antimicrob Chemother,2017,72(3):678-683.
[15] Niebel M,Perera MT,Shah T,et al.Emergence of linezolid resistance in hepatobiliary infections caused by Enterococcus faecium[J].Liver Transpl,2016,22(2):201-208.
[16] O'Driscoll C,Murphy V,Doyle O,et al.First outbreak of linezolid-resistant vancomycin-resistant Enterococcus faeciumin an Irish hospital,February to September 2014[J].J Hosp Infect,2015,91(4):367-370.
[17] McKinnell JA,Arias CA.Editorial commentary:linezolid vs daptomycin for vancomycin-resistant Enterococci:the evidence gap between trials and clinical experience[J].Clin Infect Dis,2015,61(6):879-882.
[2] Kaveh M,Bazargani A,Ramzi M,et al.Colonization rate and risk factors of vancomycin-resistant Enterococci among patients received hematopoietic stem cell transplantation in Shiraz,Southern Iran[J].Int J Cardiol Organ Transplant Med,2016,7(4):197-205.
[3]胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[4]胡付品,朱德妹,汪复,等.2014年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2015,15(5):401-410.
[5]马孝煜,蒲彰雅,姚伟明,等.耐利奈唑胺粪肠球菌感染的危险因素分析[J].微生物与感染,2017,12(4):217-221.
[6]陈亮,李真,刘颖,等.肠球菌血流感染的临床特征和预后因素分析[J].中华医院感染学杂志,2017,27(9):1944-1947.
[7] Clinical and Laboratory Standards Institute(CLSI)/NCCLS.Performance standards for antimicrobial susceptibility testing standards:nineteenth informational supplemen[S].201:M100-S20.
[8] Blair JMA,Webber MA,Baylay AJ,et al.Molecular mechanisms of antibiotic resistance[J].Nat Rev Microbiol,2015,13(1):42.
[9] Dale JL,Cagnazzo J,Phan CQ,et al.Multiple roles for Enterococcus faecalis glycosyltransferases in biofilm-associated antibiotic resistance,cell envelope integrity,and conjugative transfer[J].Antimicrob Agents Chemother,2015,59(7):4094-4105.
[10] Faron ML,Ledeboer NA,Buchan BW.Resistance mechanisms,epidemiology,and approaches to screening for vancomycin-resistant Enterococcus in the health care setting[J].J Clin Microbiol,2016,54(10):2436-2447.
[11]张莹,龚瑞娥,刘珍如,等.677例多药耐药菌医院感染病例分析[J].中华医院感染学杂志,2017,27(18):4118-4122.
[12]李万翔,刘秘,吕火烊.肠球菌耐万古霉素机制研究进展[J].中国微生态学杂志,2014,26(5):600-603.
[13] Britt NS,Potter EM,Patel N,et al.Comparison of the effectiveness and safety of linezolid and daptomycin in vancomycin-resistant enterococcal bloodstream infection:a national cohort study of Veterans Affairs patients[J].Clin Infect Dis,2015,61(6):871-878.
[14] Cavaco LM,Bernal JF,Zankari E,et al.Detection of linezolid resistance due to the optrA gene in Enterococcus faecalis from poultry meat from the American continent(Colombia)[J].J Antimicrob Chemother,2017,72(3):678-683.
[15] Niebel M,Perera MT,Shah T,et al.Emergence of linezolid resistance in hepatobiliary infections caused by Enterococcus faecium[J].Liver Transpl,2016,22(2):201-208.
[16] O'Driscoll C,Murphy V,Doyle O,et al.First outbreak of linezolid-resistant vancomycin-resistant Enterococcus faeciumin an Irish hospital,February to September 2014[J].J Hosp Infect,2015,91(4):367-370.
[17] McKinnell JA,Arias CA.Editorial commentary:linezolid vs daptomycin for vancomycin-resistant Enterococci:the evidence gap between trials and clinical experience[J].Clin Infect Dis,2015,61(6):879-882.