2012-2016年肠球菌血流感染的菌种分布与耐药性分析
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摘要
目的分析血流感染(BSI)肠球菌属菌种分布及其对抗菌药物的耐药状况。方法收集2012-2016年医院临床血培养分离到的非重复肠球菌属221株,采用VITEK-2Compact全自动微生物分析系统进行细菌鉴定及药敏测定,并使用WHONET 5.6软件对结果进行描述性统计分析。结果 221株肠球菌属细菌主要以屎肠球菌和粪肠球菌为主,分别为125株(56.6%)和74株(33.5%);221株肠球菌分离自不同科室,其中ICU、消化内科、泌尿外科的分离率列前3位,分别为68株(30.8%)、33株(14.9%)、21株(9.5%);221株肠球菌属对大多数抗菌药物的耐药率均较高,其中屎肠球菌对青霉素G、氨苄西林、高浓度链霉素、环丙沙星、左氧氟沙星、莫西沙星、红霉素、万古霉素、替考拉宁的耐药率均高于粪肠球菌(P<0.05),而粪肠球菌对四环素的耐药率高于屎肠球菌(P<0.05)。二者对利奈唑胺、万古霉素、替加环素的耐药率均较低。结论医院血流感染的肠球菌属感染以屎肠球菌为主,其耐药率高于粪肠球菌,监测肠球菌属的临床分布及耐药状况对临床治疗具有重要的指导意义。
OBJECTIVE To investigate the distribution and drug resistance of Enterococci causing bloodstream infection(BSI).METHODS Totally 221 strains of non-repetitive Enterococci were isolated from clinical blood specimens in 2012-2016,the isolated bacteria were identified by using VITEK-2 Compact automatic microorganism analysis system,the drug susceptibility testing was performed,and the descriptive statistical analysis was carried out by means of WHONET5.6 software.RESULTS Enterococcus faeciumand Enterococcus faecalis were dominant among the 221 strains of Enterococci,accounting for 56.6%(125 strains)and 33.5%(74 strains),respectively.Among the 221 strains of Enterococci,68(30.8%)were isolated from ICU,33(14.9%)were isolated from gastroenterology department,and 21(9.5%)were isolated from urology department.The 221 strains of Enterococci were highly resistant to most of the antibiotics;the drug resistance rates of the E.faeciumstrains to penicillin G,ampicillin,high concentration of streptomycin,ciprofloxacin,levofloxacin,moxifloxacin,erythromycin,vancomycin were significantly higher than those of the E.faecalis strains(P<0.05),however,the drug resistance rate of the E.faecalis strains to tetracycline was significantly higher than that of the E.faecium strains(P<0.05).The drug resistance rates of the two species of pathogens to linezolid,vancomycin,teicoplanin and tigecycline were low.CONCLUSION E.faeciumis the predominant species of Enterococci causing the bloodstream infection,the drug resistance rate of the E.faeciumstrains is higher than that of the E.faecalis,and the monitoring of clinical distribution and drug resistance of the Enterococci has great significance in clinical treatment.
OBJECTIVE To investigate the distribution and drug resistance of Enterococci causing bloodstream infection(BSI).METHODS Totally 221 strains of non-repetitive Enterococci were isolated from clinical blood specimens in 2012-2016,the isolated bacteria were identified by using VITEK-2 Compact automatic microorganism analysis system,the drug susceptibility testing was performed,and the descriptive statistical analysis was carried out by means of WHONET5.6 software.RESULTS Enterococcus faeciumand Enterococcus faecalis were dominant among the 221 strains of Enterococci,accounting for 56.6%(125 strains)and 33.5%(74 strains),respectively.Among the 221 strains of Enterococci,68(30.8%)were isolated from ICU,33(14.9%)were isolated from gastroenterology department,and 21(9.5%)were isolated from urology department.The 221 strains of Enterococci were highly resistant to most of the antibiotics;the drug resistance rates of the E.faeciumstrains to penicillin G,ampicillin,high concentration of streptomycin,ciprofloxacin,levofloxacin,moxifloxacin,erythromycin,vancomycin were significantly higher than those of the E.faecalis strains(P<0.05),however,the drug resistance rate of the E.faecalis strains to tetracycline was significantly higher than that of the E.faecium strains(P<0.05).The drug resistance rates of the two species of pathogens to linezolid,vancomycin,teicoplanin and tigecycline were low.CONCLUSION E.faeciumis the predominant species of Enterococci causing the bloodstream infection,the drug resistance rate of the E.faeciumstrains is higher than that of the E.faecalis,and the monitoring of clinical distribution and drug resistance of the Enterococci has great significance in clinical treatment.
引文
[1]Armin S,Fallah F,Karimi A,et al.Genotyping,antimicrobial resistance and virulence factor gene profiles of vancomycin resistance Enterococcus faecalis isolated from blood culture[J].Microb Pathog,2017,109:300-304.
[2]李荷楠,曾吉,金炎,等.2016年中国12家教学医院院内感染常见病原菌的分布和抗菌药物耐药监测研究[J].中华检验医学杂志,2018,41(9):651-657.
[3]杨青,俞云松,林洁,等.2005-2014年CHINET肠球菌属细菌耐药性监测[J].中国感染与化疗杂志,2016,16(2):146-152.
[4]李晓鹏,罗雯,叶寰,等.耐万古霉素屎肠球菌血流感染发生与死亡的影响因素分析[J].中华医院感染学杂志,2019,29(5):650-653.
[5]马耀,孙建芳,张学军,等.2011-2016年粪肠球菌和屎肠球菌耐药趋势分析[J].中华医院感染学杂志,2019,29(3):321-325.
[6]Carvalhaes CG,Huband MD,Reinhart HH,et al.Antimicrobial activity of omadacycline tested against clinical bacterial isolates from hospitals in Mainland China,Hong Kong,and Taiwan:results from the SENTRY Antimicrobial Surveillance Program(2013to 2016)[J].Antimicrob Agents Chemother,2019,63(3):e02262-e02318.
[7]Zhou W,Gao S,Xu H,et al.Distribution of the optrA gene in Enterococcus isolates at a tertiary care hospital in China[J].JGlob Antimicrob Resist,2019,S2213-7165(19):30008-30016.
[8]Chen M,Pan H,Lou Y,et al.Epidemiological characteristics and genetic structure of linezolid-resistant Enterococcus faecalis[J].Infect Drug Resist,2018,11:2397-2409.
[9]CLSI.Performance standards for antimicrobial susceptibility testing[S].M100-S27.Clinical and Laboratory Standards Institute,Wayne,PA,2017.
[10]Pfaller MA,Sader HS,Flamm RK,et al.Oritavancin in vitro activity against gram-positive organisms from European and United States medical centers:results from the SENTRY Antimicrobial Surveillance Program for 2010-2014[J].Diagn Microbiol Infect Dis,2018,91(2):199-204.
[11]Sachan S,Rawat V,Umesh,et al.Susceptibility pattern of Enterococci at tertiary care hospital[J].J Glob Infect Dis,2017,9(2):73-75.
[12]Zheng JX,Wu Y,Lin ZW,et al.Characteristics of and virulence factors associated with biofilm formation in clinical Enterococcus faecalis isolates in China[J].Front Microbiol,2017,8:2338.
[13]黄仁刚,杨兴详,喻华,等.肠球菌属血流感染92例临床及病原菌特点分析[J].中国感染与化疗杂志,2015,15(1):6-10.
[14]崔泽林,肖迨,冯婷婷,等.血流感染粪肠球菌和屎肠球菌的临床分布及耐药研究[J].微生物与感染,2017,12(1):29-34.
[15]石作珍,邹翠美,王惠云,等.血流感染肠球菌属细菌的临床分布及耐药性分析[J].宁夏医学杂志,2015,37(9):833-835.
[16]Timsit JF,Bassetti M,Cremer O,et al.Rationalizing antimicrobial therapy in the ICU:a narrative review[J].Intensive Care Med,2019,45(2):172-189.
[17]Campion M,Scully G.Antibiotic use in the intensive care unit:optimization and de-escalation[J].J Intensive Care Med,2018,33(12):647-655.
[18]储从家,吴惠玲,李杰芬.临床标本中肠球菌属细菌菌种分布及耐药性[J].中国感染控制杂志,2016,15(4):281-282,288.
[19]李贵玲,韩崇旭,王珏,等.血培养阳性病原菌分布及耐药性分析[J].国际检验医学杂志,2017,38(22):3174-3177.
[20]宁长秀,邱锡荣,胡利民,等.3159份血液标本中病原菌的构成和耐药性分析[J].国际检验医学杂志,2017,38(20):2893-2896.
[21]Cui L,Wang Y,Lv Y,et al.Nationwide surveillance of novel oxazolidinone resistance gene optrA in Enterococcus isolates in China from 2004to 2014[J].Antimicrob Agents Chemother,2016,60(12):7490-7493.
[22]Pfaller MA,Mendes RE,Streit JM,et al.ZAAPS Program results for 2015:an activity and spectrum analysis of linezolid using clinical isolates from medical centres in 32countries[J].J Antimicrob Chemother,2017,72(11):3093-3099.
[23]Mendes RE,Hogan PA,Jones RN,et al.Surveillance for linezolid resistance via the Zyvox Annual Appraisal of Potency and Spectrum(ZAAPS)programme(2014):evolving resistance mechanisms with stable susceptibility rates[J].J Antimicrob Chemother,2016,71(7):1860-1865.
[24]Jahansepas A,Ahangarzadeh Rezaee M,Hasani A,et al.Molecular epidemiology of vancomycin-resistant Enterococcus faecalis and Enterococcus faeciumisolated from clinical specimens in the Northwest of Iran[J].Microb Drug Resist,2018,24(8):1165-1173.
[25]Monticelli J,Knezevich A,Luzzati R,et al.Clinical management of non-faecium non-faecalis vancomycin-resistant Enterococci infection.Focus on Enterococcus gallinarum and Enterococcus casseliflavus/flavescens[J].J Infect Chemother,2018,24(4):237-246.
[2]李荷楠,曾吉,金炎,等.2016年中国12家教学医院院内感染常见病原菌的分布和抗菌药物耐药监测研究[J].中华检验医学杂志,2018,41(9):651-657.
[3]杨青,俞云松,林洁,等.2005-2014年CHINET肠球菌属细菌耐药性监测[J].中国感染与化疗杂志,2016,16(2):146-152.
[4]李晓鹏,罗雯,叶寰,等.耐万古霉素屎肠球菌血流感染发生与死亡的影响因素分析[J].中华医院感染学杂志,2019,29(5):650-653.
[5]马耀,孙建芳,张学军,等.2011-2016年粪肠球菌和屎肠球菌耐药趋势分析[J].中华医院感染学杂志,2019,29(3):321-325.
[6]Carvalhaes CG,Huband MD,Reinhart HH,et al.Antimicrobial activity of omadacycline tested against clinical bacterial isolates from hospitals in Mainland China,Hong Kong,and Taiwan:results from the SENTRY Antimicrobial Surveillance Program(2013to 2016)[J].Antimicrob Agents Chemother,2019,63(3):e02262-e02318.
[7]Zhou W,Gao S,Xu H,et al.Distribution of the optrA gene in Enterococcus isolates at a tertiary care hospital in China[J].JGlob Antimicrob Resist,2019,S2213-7165(19):30008-30016.
[8]Chen M,Pan H,Lou Y,et al.Epidemiological characteristics and genetic structure of linezolid-resistant Enterococcus faecalis[J].Infect Drug Resist,2018,11:2397-2409.
[9]CLSI.Performance standards for antimicrobial susceptibility testing[S].M100-S27.Clinical and Laboratory Standards Institute,Wayne,PA,2017.
[10]Pfaller MA,Sader HS,Flamm RK,et al.Oritavancin in vitro activity against gram-positive organisms from European and United States medical centers:results from the SENTRY Antimicrobial Surveillance Program for 2010-2014[J].Diagn Microbiol Infect Dis,2018,91(2):199-204.
[11]Sachan S,Rawat V,Umesh,et al.Susceptibility pattern of Enterococci at tertiary care hospital[J].J Glob Infect Dis,2017,9(2):73-75.
[12]Zheng JX,Wu Y,Lin ZW,et al.Characteristics of and virulence factors associated with biofilm formation in clinical Enterococcus faecalis isolates in China[J].Front Microbiol,2017,8:2338.
[13]黄仁刚,杨兴详,喻华,等.肠球菌属血流感染92例临床及病原菌特点分析[J].中国感染与化疗杂志,2015,15(1):6-10.
[14]崔泽林,肖迨,冯婷婷,等.血流感染粪肠球菌和屎肠球菌的临床分布及耐药研究[J].微生物与感染,2017,12(1):29-34.
[15]石作珍,邹翠美,王惠云,等.血流感染肠球菌属细菌的临床分布及耐药性分析[J].宁夏医学杂志,2015,37(9):833-835.
[16]Timsit JF,Bassetti M,Cremer O,et al.Rationalizing antimicrobial therapy in the ICU:a narrative review[J].Intensive Care Med,2019,45(2):172-189.
[17]Campion M,Scully G.Antibiotic use in the intensive care unit:optimization and de-escalation[J].J Intensive Care Med,2018,33(12):647-655.
[18]储从家,吴惠玲,李杰芬.临床标本中肠球菌属细菌菌种分布及耐药性[J].中国感染控制杂志,2016,15(4):281-282,288.
[19]李贵玲,韩崇旭,王珏,等.血培养阳性病原菌分布及耐药性分析[J].国际检验医学杂志,2017,38(22):3174-3177.
[20]宁长秀,邱锡荣,胡利民,等.3159份血液标本中病原菌的构成和耐药性分析[J].国际检验医学杂志,2017,38(20):2893-2896.
[21]Cui L,Wang Y,Lv Y,et al.Nationwide surveillance of novel oxazolidinone resistance gene optrA in Enterococcus isolates in China from 2004to 2014[J].Antimicrob Agents Chemother,2016,60(12):7490-7493.
[22]Pfaller MA,Mendes RE,Streit JM,et al.ZAAPS Program results for 2015:an activity and spectrum analysis of linezolid using clinical isolates from medical centres in 32countries[J].J Antimicrob Chemother,2017,72(11):3093-3099.
[23]Mendes RE,Hogan PA,Jones RN,et al.Surveillance for linezolid resistance via the Zyvox Annual Appraisal of Potency and Spectrum(ZAAPS)programme(2014):evolving resistance mechanisms with stable susceptibility rates[J].J Antimicrob Chemother,2016,71(7):1860-1865.
[24]Jahansepas A,Ahangarzadeh Rezaee M,Hasani A,et al.Molecular epidemiology of vancomycin-resistant Enterococcus faecalis and Enterococcus faeciumisolated from clinical specimens in the Northwest of Iran[J].Microb Drug Resist,2018,24(8):1165-1173.
[25]Monticelli J,Knezevich A,Luzzati R,et al.Clinical management of non-faecium non-faecalis vancomycin-resistant Enterococci infection.Focus on Enterococcus gallinarum and Enterococcus casseliflavus/flavescens[J].J Infect Chemother,2018,24(4):237-246.