Jones R N, Sader H S, Erwin M E, Anderson S C
Department of Pathology, University of Iowa College of Medicine, Iowa City 52242, USA.
Diagn Microbiol Infect Dis. 1995 Feb;21(2):85-93. doi: 10.1016/0732-8893(94)00147-o.
To assess the evolving problem of therapeutic drug resistances among enterococci, we organized a comprehensive national (United States) surveillance trial using 99 recruited microbiology laboratories in 48 of the 49 contiguous states or districts. All but two sites completed the protocol that generated information from nearly 2000 enterococci, usually isolated from blood cultures. All strains were speciated by the same method (API 20S) and were susceptibility tested by three methods (broth microdilution, disk diffusion, and Etest) against ampicillin, penicillin, vancomycin, teicoplanin, gentamicin, and streptomycin. Strains resistant to a glycopeptide or penicillin, or possessing high-level aminoglycoside resistance were referred to the monitor's laboratory for validation and additional susceptibility testing against other alternative antimicrobial agents. The most common species were Enterococcus faecalis and Enterococcus faecium. However, antimicrobial resistance occurred most often among the E. faecium isolates. Twenty-three percent of participant centers (22 sites) reported 87 vancomycin-resistant isolates, which accounts for 4.4% of the isolates evaluated. A recent audit (March 1994) of the laboratories not reporting vancomycin resistance during the study interval (October-December 1992) revealed that 61% of sites have now recognized these strains, a threefold increase in 12-15 months. Teicoplanin remained active against 28% (Van B phenotype) of vancomycin-resistant enterococci (10 E. faecalis, 13 E. faecium, and one Enterococcus spp.). Ampicillin-resistant beta-lactamase-positive strains were found only at one medical center (two strains, 0.2% of referred or validated strains); however, ampicillin-resistant strains represented 12% of all enterococcal, but nearly 60% of E. faecium strains.(ABSTRACT TRUNCATED AT 250 WORDS)
为评估肠球菌中治疗性耐药这一日益严重的问题，我们组织了一项全面的全国性（美国）监测试验，利用了49个毗连州或地区中的48个州的99家招募的微生物实验室。除两个地点外，所有地点均完成了该方案，该方案从近2000株通常从血培养中分离出的肠球菌中获取信息。所有菌株均采用相同方法（API 20S）进行分类，并通过肉汤微量稀释法、纸片扩散法和Etest法三种方法对氨苄西林、青霉素、万古霉素、替考拉宁、庆大霉素和链霉素进行药敏试验。对糖肽类或青霉素耐药，或具有高水平氨基糖苷类耐药的菌株被送至监测实验室进行验证，并针对其他替代抗菌药物进行额外的药敏试验。最常见的菌种是粪肠球菌和屎肠球菌。然而，耐药性在屎肠球菌分离株中最为常见。23%的参与中心（22个地点）报告了87株耐万古霉素分离株，占评估分离株的4.4%。最近（1994年3月）对在研究期间（1992年10月至12月）未报告耐万古霉素情况的实验室进行的一次审计显示，61%的地点现已识别出这些菌株，在12至15个月内增加了两倍。替考拉宁对28%（Van B表型）的耐万古霉素肠球菌（10株粪肠球菌、13株屎肠球菌和1株肠球菌属）仍有活性。仅在一个医疗中心发现了耐氨苄西林的β-内酰胺酶阳性菌株（两株，占送检或验证菌株的0.2%）；然而，耐氨苄西林菌株占所有肠球菌的12%，但在屎肠球菌菌株中近占60%。（摘要截选至250词）
