Bogomolova N S, Bol'shakov L V, Kuznetsova S M, Oreshkina T D
Antibiot Khimioter. 2011;56(5-6):37-45.
The dynamics of isolation of staphylococci and enterococci from clinical material of patients and their antibiotic susceptibility within a 5-year period (2005-2009) was analysed. 5990 isolates were tested: 1250 isolates of Staphylococcus aureus, 3268 isolates of S. epidermidis, 1005 isolates of Enterococcus faecalis and 467 isolates of E. faecium. Grampositive infections were shown to be prevailing within the last 2-3 years, the nosocomial epidermal staphylococci more and more replacing S. aureus (the ratio of S. epidermidis and S. aureus in 2009 was 3.3). The isolation rate of E. faecalis significantly increased (by 3.5 times) and the ratio of E. faecalis and E. faecium in 2009 was 4.3. The microflora composition with respect to the isolation source was analysed and its clinical significance was estimated. The study of the antibiotic susceptibility showed that oxacillin had its own specific niche, while antibiotics active against resistant grampositive cocci, such as rifampicin, fusidic acid, fluoroquinolones (moxifloxacin), cefoxitin, as well as amoxicillin/clavulane in infections due to E. faecalis, might be considered as the drugs of choice. In the treatment of nosocomial infections, when the etiological role of MRSA or VRE is suspected or confirmed, the complex therapy should obligatory include the most active antibiotics (vancomycin or linezolid among them).
分析了2005年至2009年5年间从患者临床材料中分离葡萄球菌和肠球菌的动态情况及其抗生素敏感性。共检测了5990株分离菌：1250株金黄色葡萄球菌、3268株表皮葡萄球菌、1005株粪肠球菌和467株屎肠球菌。结果显示，革兰氏阳性菌感染在过去2至3年中占主导地位，医院内表皮葡萄球菌越来越多地取代金黄色葡萄球菌（2009年表皮葡萄球菌与金黄色葡萄球菌的比例为3.3）。粪肠球菌的分离率显著增加（增加了3.5倍），2009年粪肠球菌与屎肠球菌的比例为4.3。分析了分离源的微生物群落组成并评估了其临床意义。抗生素敏感性研究表明，苯唑西林有其特定的适用范围，而对耐药革兰氏阳性球菌有效的抗生素，如利福平、夫西地酸、氟喹诺酮类（莫西沙星）、头孢西丁，以及在粪肠球菌感染中使用的阿莫西林/克拉维酸，可被视为首选药物。在治疗医院感染时，当怀疑或确认耐甲氧西林金黄色葡萄球菌（MRSA）或耐万古霉素肠球菌（VRE）的病因学作用时，联合治疗应必须包括最有效的抗生素（其中包括万古霉素或利奈唑胺）。
