Gutiérrez J, Hoyos A, Piedrola G
Departamento de Microbiologia, Hospital Universitario San Cecilio, Universidad de Granada, Spain.
Ann Biol Clin (Paris). 1992;50(10-11):671-4.
In recent years enterococci have been isolated with increasing frequency in association with serious infections. Suitable therapy for empirical treatment can only be chosen on the basis of susceptibility studies. The synergistic effects obtained by the combination of aminoglycosides with penicillin or vancomycin disappear in strains that show high level resistance (HLR) to the former. This highlights the importance of correct identification of the species of Enterococcus (especially Enterococcus faecium, a particularly resistant species), and of studies designed to examine HLR in severe infections. The preferred methods are dilution in solid or liquid medium with 2,000 micrograms of aminoglycoside per ml, or diffusion in solid medium from discs impregnated with 120 micrograms of gentamicin (which also predicts the microorganism's susceptibility to tobramycin and netilmicin) or kanamycin (which also predicts the response to amikacin), and 300 micrograms of streptomycin, for Enterococcus faecalis. The reliability of automated systems for the prediction of HLR to aminoglycosides has yet to be assessed.
近年来，肠球菌与严重感染相关的分离频率不断增加。只有根据药敏试验才能选择合适的经验性治疗方案。氨基糖苷类与青霉素或万古霉素联合使用所产生的协同作用在对前者表现出高水平耐药（HLR）的菌株中消失。这凸显了正确鉴定肠球菌种类（尤其是粪肠球菌，一种特别耐药的菌种）以及在严重感染中检测HLR的研究的重要性。首选方法是在固体或液体培养基中进行稀释，每毫升含有2000微克氨基糖苷类药物，或在固体培养基中进行扩散试验，使用含120微克庆大霉素（这也可预测微生物对妥布霉素和奈替米星的敏感性）或卡那霉素（这也可预测对阿米卡星的反应）的纸片，对于粪肠球菌则使用含300微克链霉素的纸片。用于预测对氨基糖苷类药物HLR的自动化系统的可靠性尚未得到评估。
