Tian L L, Xing B B, Zhang Y M, Zhao J P
Health Ward Inner Mongolia Autonomous Region People's Hospital,Hohhot 010010, China.
Laboratory Department,Inner Mongolia Autonomous Region People's Hospital,Hohhot 010010, China.
Zhonghua Yu Fang Yi Xue Za Zhi. 2024 Aug 6;58(8):1242-1246. doi: 10.3760/cma.j.cn112150-20231120-00354.
To investigate the strain composition and drug resistance characteristics of G(Gram positive cocci) cocci causing bloodstream infections in the People's Hospital of Inner Mongolia Autonomous Region in recent years and provide a basis for the empirical and rational use of drugs for the prevention and treatment of bloodstream infections caused by Gcocci. The strain composition and drug-resistant characteristics of Gcocci isolated from positive blood culture specimens sent to various departments of the Inner Mongolia Autonomous Region People's Hospital from January 2015 to December 2022 were retrospectively analyzed, and the higher detection rates of Staphylococcus hominis and Staphylococcus epidermidis, Enterococcus faecium and Enterococcus faecalis, and methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) were examined. MRSA and methicillin-sensitive Staphylococcus aureus (MSSA) were comparatively analyzed for resistance. The resistance data were analyzed by Whonet 5.6 statistical software, the significance of difference was analyzed by SPSS 22.0 software, and the resistance rate was compared by test. The results showed that 1 209 strains of Gcocci, in terms of the composition ratio, from high to low, were mainly human staphylococci (32.5%,393/1 209), Staphylococcus epidermidis (27.8%, 336/1 209), Staphylococcus aureus (14.9%,180/1 209) and Enterococcus faecalis (10.6%, 128/1 209). Among them, the detection rate of methicillin-resistant Staphylococcus aureus (MRSA) (42.8%, 77/180) was lower than that of methicillin-resistant coagulase-negative staphylococcus (MRCNS) (71.5%, 608/850); and among enterococci, the detection rate of Enterococcus faecalis (71.5%, 128/179) was much higher than that of Enterococcus faecalis (28.5%, 51/179). For drug resistance, the resistance rate to five commonly used antimicrobial drugs, ciprofloxacin, levofloxacin, moxifloxacin, clindamycin and tetracycline, was higher in Staphylococcus hominis than in Staphylococcus epidermidis (=7.152-64.080, <0.05); however, for the aminoglycoside antimicrobial drug gentamicin, the rate of resistance in Staphylococcus humanus was lower than in Staphylococcus epidermidis, and the difference was statistically significant (=11.895, 0.05); no strains resistant to linezolid and vancomycin were found in both. Comparison of the resistance rates to seven antimicrobial drugs, gentamicin, rifampicin, ciprofloxacin, levofloxacin, moxifloxacin, clindamycin and tetracycline, was significantly higher in MRSA than in MSSA (=6.169-56.941, <0.05); however, the resistance rate to cotrimoxazole, MRSA (15.6%, 12/77) was significantly lower than that of MSSA (35.3%, 36/102), and the difference was statistically significant (=5.155, 0.05); MRSA and MSSA resistant to linezolid and vancomycin were not found. The resistance rate of Enterococcus faecalis to penicillin G and ampicillin was much higher than that of Enterococcus faecalis, and the difference was statistically significant (=22.965, <0.05), and vancomycin-resistant enterococci (VRE) were not found. In conclusion, for staphylococci, except for individual antibiotics, S.hominis and MRSA were more resistant to most antimicrobial drugs than S. epidermidis and MSSA, showing a multidrug-resistant pattern. For enterococci, except for penicillin G and ampicillin resistance rate, Enterococcus faecalis is much higher than Enterococcus faecalis, the rest of the antimicrobial drugs did not see a significant difference, in addition to vancomycin-resistant enterococci were not detected. Clinicians should pay great attention to the monitoring data of multidrug-resistant Gcocci isolated from blood cultures to provide a basis for empirical and rational use of drugs in the clinic, to effectively prevent and reduce the incidence of bloodstream infections caused by Gcocci.
为探讨近年来内蒙古自治区人民医院引起血流感染的革兰阳性球菌（G球菌）的菌株构成及耐药特征，为临床预防和治疗G球菌所致血流感染的经验性及合理用药提供依据。回顾性分析2015年1月至2022年12月内蒙古自治区人民医院各科室送检的血培养阳性标本中分离出的G球菌的菌株构成及耐药特征，考察人葡萄球菌、表皮葡萄球菌、粪肠球菌和屎肠球菌，以及耐甲氧西林金黄色葡萄球菌（MRSA）和甲氧西林敏感金黄色葡萄球菌（MSSA）的较高检出率。对MRSA和甲氧西林敏感金黄色葡萄球菌（MSSA）的耐药性进行比较分析。耐药数据采用Whonet 5.6统计软件进行分析，差异显著性采用SPSS 22.0软件进行分析，耐药率采用检验进行比较。结果显示，1209株G球菌，按构成比从高到低依次主要为人葡萄球菌（32.5%，393/1209）、表皮葡萄球菌（27.8%，336/1209）、金黄色葡萄球菌（14.9%，180/1209）和粪肠球菌（10.6%，128/1209）。其中，耐甲氧西林金黄色葡萄球菌（MRSA）的检出率（42.8%，77/180）低于耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）（71.5%，608/850）；在肠球菌中，粪肠球菌的检出率（71.5%，128/179）远高于屎肠球菌（28.5%，51/179）。在耐药性方面，人葡萄球菌对环丙沙星、左氧氟沙星、莫西沙星、克林霉素和四环素5种常用抗菌药物的耐药率高于表皮葡萄球菌（=7.152 - 64.080，<0.05）；然而，对于氨基糖苷类抗菌药物庆大霉素，人葡萄球菌的耐药率低于表皮葡萄球菌，差异有统计学意义（=11.895，0.05）；两者均未发现对利奈唑胺和万古霉素耐药的菌株。MRSA对庆大霉素、利福平、环丙沙星、左氧氟沙星、莫西沙星、克林霉素和四环素7种抗菌药物的耐药率显著高于MSSA（=6.169 - 56.941，<0.05）；然而，对复方新诺明的耐药率，MRSA（15.6%，12/77）显著低于MSSA（35.3%，36/102），差异有统计学意义（=5.155，0.05）；未发现对利奈唑胺和万古霉素耐药的MRSA和MSSA。粪肠球菌对青霉素G和氨苄西林的耐药率远高于屎肠球菌，差异有统计学意义（=22.965，<0.05），未发现耐万古霉素肠球菌（VRE）。综上所述，对于葡萄球菌，除个别抗生素外，人葡萄球菌和MRSA对多数抗菌药物的耐药性高于表皮葡萄球菌和MSSA，呈现多重耐药模式。对于肠球菌，除青霉素G和氨苄西林耐药率粪肠球菌远高于屎肠球菌外，其余抗菌药物未见显著差异，此外未检测到耐万古霉素肠球菌。临床医生应高度重视从血培养中分离出的多重耐药G球菌的监测数据，为临床经验性及合理用药提供依据，有效预防和降低G球菌所致血流感染的发生率。
