[肠球菌属耐药性，一个日益严重的问题。流行病学研究（1987 - 1993年）]

[Enterococcus sp. resistance, a growing problem. Epidemiologic study (1987-1993)].

作者信息

Sáenz González M C, Valero Juan L F

机构信息

Departamento de Medicina Preventiva, Facultad de Medicina, Universidad de Salamanca.

出版信息

Med Clin (Barc). 1994 Oct 22;103(13):485-9.

PMID:7996905

Abstract

BACKGROUND

Infectious processes caused by Enterococcus species currently constitute a growing problem due to the rapid appearance of resistances and the scarce existing therapeutic alternatives. The patterns of in vitro resistance to ampicillin, vancomycin and gentamycin were therefore studied in addition to their evolution over time of the isolates of Enterococcus sp. identified in the Salamanca University Hospital from 1987-1993.

METHODS

Data were obtained from a computerized system of epidemiologic surveillance of infection in in-patients on the basis of microbiologic information. Sensitivity tests were performed by the disc-plate diffusion method of the National Clinical Committee for Laboratory Standards.

RESULTS

Global resistance was 2.1% to vancomycin versus 8.3% to ampicillin with most of the isolates being resistant to gentamycin. The frequency of appearance of resistance increased over time with 19.6% of the strains found to be resistant to ampicillin (p < 0.05; CI 95%, 1987-1988: 12.2-24.3%) in 1993 and from 1991-1992 2.7% were found to be resistant to vancomycin. The strains from patients from the medical area were more resistant to ampicillin (p < 0.05; CI 95%, 0.8-7.4%) and vancomycin (p < 0.05; CI 95%, 0.2-3.9%) than those corresponding to patients from the surgical area. Greater resistance was identified to ampicillin and vancomycin in the isolates from urine and wound exudates. Patients under the age of 1 year were significantly less resistant to ampicillin (p < 0.05; CI 95%, with respect to the group from 21 to 40 years: 1.6-13.9%) and vancomycin with the greatest resistance being found from 41 to 60 years of age. E. faecalis (2.9% resistance) was more resistant to vancomycin and E. faecium was more resistant to ampicillin (27.8% resistant strains) (p < 0.05: CI 95%, 3.2-33.6%).

CONCLUSIONS

Over time there has been a rapid increase in the number of enterococci resistant to ampicillin while, to date, vancomycin shows good activity against these bacteria.

摘要

背景

由于耐药性迅速出现且现有治疗选择稀缺，肠球菌属引起的感染性疾病目前正成为一个日益严重的问题。因此，除了研究1987 - 1993年在萨拉曼卡大学医院鉴定出的肠球菌属分离株随时间的演变情况外，还研究了它们对氨苄西林、万古霉素和庆大霉素的体外耐药模式。

方法

基于微生物学信息，从住院患者感染的计算机化流行病学监测系统中获取数据。敏感性试验采用美国国家临床实验室标准委员会的纸片扩散法进行。

结果

对万古霉素的总体耐药率为2.1%，对氨苄西林的耐药率为8.3%，大多数分离株对庆大霉素耐药。随着时间的推移，耐药出现的频率增加，1993年发现19.6%的菌株对氨苄西林耐药（p < 0.05；95%置信区间，1987 - 1988年：12.2 - 24.3%），1991 - 1992年发现2.7%的菌株对万古霉素耐药。来自内科区域患者的菌株对氨苄西林（p < 0.05；95%置信区间，0.8 - 7.4%）和万古霉素（p < 0.05；95%置信区间，0.2 - 3.9%）的耐药性高于外科区域患者相应的菌株。在尿液和伤口渗出液分离株中发现对氨苄西林和万古霉素的耐药性更高。1岁以下的患者对氨苄西林（p < 0.05；95%置信区间，相对于21至40岁组：1.6 - 13.9%）和万古霉素的耐药性明显较低，耐药性最高的是41至60岁的患者。粪肠球菌（耐药率2.9%）对万古霉素的耐药性更强，屎肠球菌对氨苄西林的耐药性更强（耐药菌株27.8%）（p < 0.05：95%置信区间，3.2 - 33.6%）。