Henwood C J, Livermore D M, Johnson A P, James D, Warner M, Gardiner A
Antibiotic Resistance Monitoring and Reference Laboratory, Central Public Health Laboratory, Colindale Avenue, London NW9 5HT, UK.
J Antimicrob Chemother. 2000 Dec;46(6):931-40. doi: 10.1093/jac/46.6.931.
The prevalence of antibiotic resistance amongst Gram-positive cocci from 25 UK hospitals was studied over an 8 month period in 1999. A total of 3770 isolates were tested by the sentinel laboratories using the Etest; these bacteria comprised 1000 pneumococci, 1005 Staphylococcus aureus, 769 coagulase-negative staphylococci (CNS) and 996 enterococci. To ensure quality, 10% of the isolates were retested centrally, as were any found to express unusual resistance patterns. The prevalence of penicillin-resistant Streptococcus pneumoniae, vancomycin-resistant enterococci and methicillin-resistant S. aureus (MRSA) varied widely amongst the sentinel laboratories. The resistance rates to methicillin among S. aureus and CNS were 19.2 and 38.9%, respectively, with MRSA rates in individual sentinel sites ranging from 0 to 43%. No glycopeptide resistance was seen in S. aureus, but 6.5% of CNS isolates were teicoplanin resistant and 0.5% were vancomycin resistant. Vancomycin resistance was much more frequent among Enterococcus faecium (24.1%) than E. faecalis (0.5%) (P<0.05), with most resistant isolates carrying vanA. The rate of penicillin resistance in pneumococci was 8.9%, and this resistance was predominantly intermediate (7.9%), with only six hospitals reporting isolates with high level resistance. The prevalence of erythromycin resistance among pneumococci was 12.3%, with the majority of resistant isolates having the macrolide efflux mechanism mediated by mefE. All the organisms tested were susceptible to linezolid with MICs in the range 0.12-4 mg/L. The modal MICs of linezolid were 1 mg/L for CNS and pneumococci, and 2 mg/L for S. aureus and enterococci. Linezolid was the most potent agent tested against Gram-positive cocci, including multiresistant strains, and as such may prove a valuable therapeutic option for the management of Gram-positive infections in hospitals.
1999年，在8个月的时间里，对来自英国25家医院的革兰氏阳性球菌的抗生素耐药性流行情况进行了研究。哨兵实验室使用Etest对总共3770株分离菌进行了检测；这些细菌包括1000株肺炎球菌、1005株金黄色葡萄球菌、769株凝固酶阴性葡萄球菌（CNS）和996株肠球菌。为确保质量，10%的分离菌进行了集中重新检测，任何表现出异常耐药模式的分离菌也进行了重新检测。哨兵实验室中耐青霉素肺炎链球菌、耐万古霉素肠球菌和耐甲氧西林金黄色葡萄球菌（MRSA）的流行率差异很大。金黄色葡萄球菌和CNS对甲氧西林的耐药率分别为19.2%和38.9%，个别哨兵站点的MRSA率在0%至43%之间。在金黄色葡萄球菌中未发现糖肽耐药性，但6.5%的CNS分离株对替考拉宁耐药，0.5%对万古霉素耐药。粪肠球菌（24.1%）的万古霉素耐药性比屎肠球菌（0.5%）更常见（P<0.05），大多数耐药分离株携带vanA。肺炎球菌的青霉素耐药率为8.9%，这种耐药性主要为中介耐药（7.9%），只有6家医院报告了高水平耐药的分离株。肺炎球菌中红霉素耐药率为12.3%，大多数耐药分离株具有由mefE介导的大环内酯外排机制。所有检测的菌株对利奈唑胺敏感，MIC范围为0.12 - 4mg/L。利奈唑胺对CNS和肺炎球菌的MIC模式值为1mg/L，对金黄色葡萄球菌和肠球菌为2mg/L。利奈唑胺是检测的针对革兰氏阳性球菌（包括多重耐药菌株）最有效的药物，因此可能被证明是医院治疗革兰氏阳性感染的一种有价值的治疗选择。
