[住院患者中耐万古霉素和高水平氨基糖苷类肠球菌的携带情况及与耐药相关的危险因素]

[Vancomycin and high-level aminoglycoside resistant Enterococcus carriage and the risk factors related to resistance in hospitalized patients].

作者信息

Yildirim Mustafa, Sencan Irfan, Ozdemir Davut, Oksüz Sükrü, Yilmaz Zeynep, Sahin Idris

出版信息

Mikrobiyol Bul. 2007 Apr;41(2):271-7.

Abstract

The aims of this study were to detect the prevalence of fecal vancomycin resistant Enterococcus (VRE) colonization with high-level resistance to aminoglycoside and other antibiotics and, the risk factors related to resistance in hospitalized patients in Düzce Medical Faculty Hospital, Turkey. A total of 105 patients (61 from internal medicine, 44 from surgery clinics; 54.3% female, mean age: 47.2 +/- 24.54 years) were included to the study and a single stool sample was collected from each of the patients. Specimens were cultivated in Enterococcus selective media (BioMerieux, France), and the isolates were identified by conventional microbiological methods together with the API 20 Strep test. Beta-lactamase activities of the isolates were tested with nitrocefin disk, and antibiotic susceptibilities were determined by the disk diffusion method. Enterococcus spp. were isolated from 81 (77%) of the patients' samples and 60.5% were identified as E. faecium, 13.6% as E. faecalis, 11.1% as E. gallinarum, 7.4% as E. durans, 2.5% as E. raffinosus, 2.5% as E. mundtii, 1.2% as E. casseliflavus, and 1.2% as E. avium. High-level streptomycin and gentamicin resistance rates were found in 19.8% and 9.9% of the isolates, respectively. The resistance rates for the other antibiotics were found as follows; 18.5% to ampicillin, 27.2% to penicilin, 34.6% to nitrofurantoin, 65.4% to norfloxacin, and 70.4% to both tetracycline and ciprofloxacin. No vancomycin resistance was detected, and none of the enterococci had beta-lactamase activity. Long hospitalization period, antibiotic usage and experience of intra-abdominal operation were found as the significant risk factors for colonization of the resistant bacteria. Our results demonstrated that there was no fecal VRE carriage in our hospital during the study period, however, it was concluded that the screening tests should be done periodically in order to detect resistant strains as soon as possible.

摘要

本研究的目的是检测土耳其杜兹切医学院医院住院患者中对万古霉素耐药的肠球菌（VRE）的定植情况，这些肠球菌对氨基糖苷类抗生素和其他抗生素具有高水平耐药性，以及与耐药相关的危险因素。共有105例患者（内科61例，外科门诊44例；女性占54.3%，平均年龄：47.2±24.54岁）纳入本研究，从每位患者采集一份粪便样本。样本在肠球菌选择性培养基（法国生物梅里埃公司）中培养，分离株通过传统微生物学方法及API 20 Strep试验进行鉴定。用硝基头孢菌素纸片检测分离株的β-内酰胺酶活性，采用纸片扩散法测定抗生素敏感性。从81例（77%）患者样本中分离出肠球菌属，其中60.5%鉴定为屎肠球菌，13.6%为粪肠球菌，11.1%为鹑鸡肠球菌，7.4%为耐久肠球菌，2.5%为棉子糖肠球菌，2.5%为蒙氏肠球菌，1.2%为卡氏黄色肠球菌，1.2%为鸟肠球菌。分离株中高水平链霉素和庆大霉素耐药率分别为19.8%和9.9%。其他抗生素的耐药率如下：氨苄西林为18.5%，青霉素为27.2%，呋喃妥因为34.6%，诺氟沙星为65.4%，四环素和环丙沙星均为70.4%。未检测到万古霉素耐药，且所有肠球菌均无β-内酰胺酶活性。发现住院时间长、使用抗生素和有腹部手术史是耐药菌定植的重要危险因素。我们的结果表明，在研究期间我院未发现粪便VRE携带情况，然而，得出的结论是应定期进行筛查试验以便尽快检测到耐药菌株。