Shrestha Nabin K, Chua Jimmy D, Tuohy Marion J, Wilson Deborah A, Procop Gary W, Longworth David L, Isada Carlos M, Hall Gerri S
Department of Infectious Diseases, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Scand J Infect Dis. 2003;35(1):12-4. doi: 10.1080/0036554021000026985.
The increasing prevalence of vancomycin-resistant enterococcal (VRE) infections has necessitated a search for drugs that are effective in treating these infections, and a need to determine whether currently available antimicrobials are effective. 75 consecutive clinical isolates of vancomycin-resistant Enterococcus faecium (VRE faecium) (40 blood and 35 urine isolates) isolated over 1 y at the Cleveland Clinic Foundation were tested for susceptibility to linezolid, quinupristin-dalfopristin, fosfomycin and nitrofurantoin using the Etest. The minimum inhibitory concentrations were read independently by 3 observers and compared, and a final reading was obtained by predetermined criteria. The proportion of isolates susceptible to linezolid, quinupristin-dalfopristin, fosfomycin and nitrofurantoin was 100%, 98.7%, 98.7% and 78.7%, respectively. No single isolate was resistant to more than 1 of the 4 drugs tested. Etest presented significant unexpected difficulties in testing for VRE faecium susceptibility to nitrofurantoin. Fosfomycin may be a useful alternative to linezolid and quinupristin-dalfopristin in the treatment of VRE infections in certain clinical situations, e.g. uncomplicated urinary tract infections. In addition, the use of fosfomycin could limit the use of newer agents, thus reducing the chance of development of further resistance in the enterococci.
耐万古霉素肠球菌（VRE）感染的日益普遍使得人们必须寻找能有效治疗这些感染的药物，并确定现有抗菌药物是否有效。在克利夫兰诊所基金会，对1年多来连续分离出的75株耐万古霉素屎肠球菌（VRE屎肠球菌）临床分离株（40株血液分离株和35株尿液分离株），使用Etest法检测其对利奈唑胺、奎奴普丁 - 达福普汀、磷霉素和呋喃妥因的敏感性。最低抑菌浓度由3名观察者独立读取并进行比较，最终结果依据预定标准得出。对利奈唑胺、奎奴普丁 - 达福普汀、磷霉素和呋喃妥因敏感的分离株比例分别为100%、98.7%、98.7%和78.7%。没有单个分离株对所测试的4种药物中的超过1种耐药。在检测VRE屎肠球菌对呋喃妥因的敏感性时，Etest法出现了显著的意外困难。在某些临床情况下，如单纯性尿路感染，磷霉素可能是利奈唑胺和奎奴普丁 - 达福普汀治疗VRE感染的有用替代药物。此外，使用磷霉素可以限制新型药物的使用，从而减少肠球菌产生进一步耐药性的机会。
