Low D E, Willey B M, Betschel S, Kreiswirth B
Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada.
Eur J Surg Suppl. 1994(573):19-24.
The genus Enterococcus consists of at least 12 species, two of which account for over 95% of the clinically important strains, E faecalis (85%-90%) and E faecium (5%-10%). Despite their ubiquity and frequent isolation, they have not been thought to cause serious disease because they lack common virulence factors. Now, however, enterococci are regarded as true pathogens and are the second leading cause of nosocomial infections. This change results from their increasing antimicrobial resistance and the extensive use of antimicrobial drugs (for example-cephalosporins) that are not active against them. Serious infections should usually be treated with a beta-lactam and an aminoglycoside, but glycopeptides have been increasingly used during the last decade. Two novel resistance patterns of particular concern recently are high level aminoglycoside resistance (HLAR) and vancomycin resistance. The prevalence of HLAR is between 15% and 55%, and glycopeptide resistance has become widespread in various geographical areas. This poses a serious problem, as such resistance may spread to other Gram-positive organisms and is often associated with resistance to other antimicrobial drugs. This may theoretically result in groups of organisms for which there will be no effective antimicrobial treatment.
肠球菌属至少由12个菌种组成，其中两种占临床上重要菌株的95%以上，即粪肠球菌（85%-90%）和屎肠球菌（5%-10%）。尽管它们无处不在且经常被分离出来，但由于缺乏常见的毒力因子，以前人们认为它们不会引起严重疾病。然而现在，肠球菌被视为真正的病原体，是医院感染的第二大主要原因。这种变化是由于它们日益增强的抗菌耐药性以及对它们无活性的抗菌药物（如头孢菌素）的广泛使用所致。严重感染通常应用β-内酰胺类药物和氨基糖苷类药物进行治疗，但在过去十年中糖肽类药物的使用越来越多。最近特别值得关注的两种新的耐药模式是高水平氨基糖苷类耐药（HLAR）和万古霉素耐药。HLAR的发生率在15%至55%之间，糖肽类耐药在不同地理区域已广泛存在。这带来了一个严重问题，因为这种耐药性可能传播到其他革兰氏阳性菌，并且常常与对其他抗菌药物的耐药性相关。从理论上讲，这可能导致出现一些没有有效抗菌治疗方法的菌群。
