Menteş Ozlem, Balci Iclal
Gaziantep Universitesi Tip Fakültesi, Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dali, Gaziantep.
Mikrobiyol Bul. 2007 Oct;41(4):585-9.
The aim of this study was to identify the Enterococcus spp. and to determine their vancomycin-resistance profiles, in the samples collected from the patients who were described as risky groups for vancomycin-resistant enterococcal (VRE) colonization, in scope of a survey study carried out in our hospital for the first time. Rectal swab samples were taken once in a month from a total of 180 patients who were hospitalized in the Surgery and Intensive Care Units, adult Oncology-Hematology and Pediatric Oncology Units between March-December 2006. The samples were cultivated onto bile-esculine agar media, and Miniapi system (bioMerieux, France) was used for the identification at species-level (Rapid ID 32 Strep kit, bioMerieux, France) and for the detection of antimicrobial susceptibilities (ATB Enterococcus kit, bioMerieux, France). MIC levels have been determined by the use of vancomycin E-test (AB Biodisk, Sweden) strips in brain-heart infusion agar (Merck, France). According to the culture results, 126 of the patients (70%) have been found to be colonized with Enterococcus spp. The most frequently isolated species were as follows respectively; E. faecium (42%), E. faecalis (31%), E. avium (12%), E. gallinarum (8%) and E. casseliflavus, (5.6%). Four of the E. faecium strains (3.2%) were found resistant to vancomycin by both automated antibiotic susceptibility test system and E-test (MIC >256 mg/ml). Vancomycin-resistant strains have been identified as being VanA genotypes by polymerase chain reaction. Beta-lactamase production has not been detected in any one of the strains with the use of nitrocephin (Remel, U.S.A.) disk. As a result the colonization rates of enterococcal species and VRE were found as 70% and 3.2%, respectively in our patients. Infections with VRE have not been detected in colonized patients during the follow-up period. In conclusion, in order to detect and prevent the spread of VRE, surveillance cultures should be regularly performed from hospitalized patients, in collaboration with educational studies for hospital personel, controlling the use of vancomycin and cephalosporins and cooperation between microbiology laboratories and inpatient clinics.
本研究的目的是，在我院首次开展的一项调查研究范围内，从被描述为耐万古霉素肠球菌（VRE）定植风险组的患者所采集的样本中，鉴定肠球菌属并确定其万古霉素耐药谱。2006年3月至12月期间，每月从外科、重症监护病房、成人肿瘤血液科和儿科肿瘤科共180例住院患者中采集一次直肠拭子样本。将样本接种于胆汁七叶苷琼脂培养基上，使用Miniapi系统（法国生物梅里埃公司）进行种水平鉴定（快速鉴定32链球菌试剂盒，法国生物梅里埃公司）以及检测抗菌药物敏感性（ATB肠球菌试剂盒，法国生物梅里埃公司）。在脑心浸液琼脂（法国默克公司）中使用万古霉素E-test（瑞典AB生物盘公司）试纸条测定MIC水平。根据培养结果，发现126例患者（70%）被肠球菌属定植。最常分离出的菌种依次如下：屎肠球菌（42%）、粪肠球菌（31%）、鸟肠球菌（12%）、鹑鸡肠球菌（8%）和格氏肠球菌（5.6%）。通过自动抗生素敏感性测试系统和E-test均发现，4株屎肠球菌菌株（3.2%）对万古霉素耐药（MIC>256mg/ml）。通过聚合酶链反应鉴定出耐万古霉素菌株为VanA基因型。使用头孢硝噻吩（美国Remel公司）试纸条未在任何一株菌株中检测到β-内酰胺酶产生。结果发现，在我们的患者中，肠球菌属和VRE的定植率分别为70%和3.2%。在随访期间，未在定植患者中检测到VRE感染。总之，为了检测和预防VRE的传播，应定期对住院患者进行监测培养，并开展针对医院工作人员的教育研究，控制万古霉素和头孢菌素的使用，以及微生物实验室与住院病房之间的合作。
