Page 111 - 《中国药房》2022年10期

耐万古霉素肠球菌患者的临床分布特点及耐药性分析

袁 妍 ，朱卫民（重庆医科大学附属第一医院感染科，重庆 400016）
#
＊
中图分类号 R446.5 文献标志码 A 文章编号 1001-0408（2022）10-1253-05
DOI 10.6039/j.issn.1001-0408.2022.10.16

摘 要 目的 研究耐万古霉素肠球菌（VRE）患者的临床分布特点及耐药情况，为临床预防及感染控制提供参考。方法 纳入
2017 年 5 月 1 日－2020 年 5 月 1 日我院住院部各科室送检标本培养出肠球菌的患者，共 290 例，根据其药敏结果分为 VRE 组（24
例）和万古霉素敏感肠球菌（VSE）组（266例）。收集患者的基本信息（性别、年龄、送检科室等）、基础疾病（高血压、糖尿病、慢性阻
塞性肺疾病等）、临床事件（导尿、气管插管、深静脉置管等）、抗菌药物使用情况（检出前后抗菌药物使用情况及使用时间）、临床表
现（炎症指标异常、临床症状等）、临床结局（住院时间、好转等）、药敏谱等，比较分析两组的临床分布特点及耐药情况。结果 两组
患者检出肠球菌的菌种种类、混合感染菌株类型、临床表现均有明显差异（P＜0.05）。VRE组中，有66.7％、20.8％的患者检出了鹑
鸡肠球菌、铅黄肠球菌这两种天然耐药菌，屎肠球菌仅对利奈唑胺、替考拉宁和替加环素敏感（耐药率均为0），对其余抗菌药物均
耐药（耐药率均为100％）；未检出粪肠球菌。VSE组中，有51.9％、44.7％的患者检出了屎肠球菌、粪肠球菌，屎肠球菌除对利奈唑
胺、替考拉宁和替加环素的耐药率较低（耐药率≤0.72％）外，对其余抗菌药物的耐药率均大于55％；粪肠球菌对克林霉素、红霉素
的耐药率均大于60％，对其余抗菌药物的敏感率均大于60％。结论 我院VRE感染菌种以鹑鸡肠球菌、铅黄肠球菌等天然耐药菌
为主，且存在对万古霉素耐药的屎肠球菌。不同菌种对不同抗菌药物的耐药率及敏感率差异较大。
关键词 肠球菌；万古霉素；临床分布；耐药情况
Analysis of clinical distribution and drug resistance of vancomycin-resistant Enterococci
YUAN Yan，ZHU Weimin（Dept. of Infectious Diseases，the First Affiliated Hospital of Chongqing Medical

University，Chongqing 400016，China）

ABSTRACT OBJECTIVE To study the characteristics of clinical distribution and drug resistance in patients with
vancomycin-resistant Enterococci（VRE），and to provide reference for clinical prevention and control of infection. METHODS
From May 1，2017 to May 1，2020，a total of 290 patients with Enterococci cultured from the samples submitted by inpatient
department of our hospital were included. They were divided into VRE group（24 cases）and vancomycin-sensitive Enterococci
（VSE）group（266 cases）according to the results of sensitivity tests. The basic information of patients（gender，age，submitting
department， etc.）， basic diseases （hypertension， diabetes， chronic obstructive pulmonary disease， etc.）， clinical events
（catheterization，endotracheal intubation，deep venous catheterization，etc.），use of antibiotics（utilization and utilization time of
antibiotics before and after detection），clinical manifestations （abnormal inflammatory indicators，clinical symptoms，etc.），
clinical outcomes（length of stay，improvement，etc.），drug sensitivity spectrum were all collected. Clinical distribution and drug
resistance were compared and analyzed between 2 groups. RESULTS There were significant differences in the type of Enterococci，
mixed infection strains and clinical manifestations between 2 groups（P＜0.05）. In VRE group，two natural drug-resistant bacteria
were detected in 66.7％ and 20.8％ of the patients，i.e. Enterococcus gallinarum and E. casseliflavus. E. faecium was only sensitive
to linezolid，teicoplanin and tegacyclin（the drug resistance rate was 0），and was resistant to other antibiotics（the drug resistance
rate was 100％）；E. faecalis was not detected. E. faecium and E. faecalis were detected in 51.9％ and 44.7％ of patients in VSE
group. The resistance rates of E. faecium to other antibiotics were more than 55％ except linezolid，teicoplanin and tegacyclin
（resistance rate≤0.72％）；the resistance rates of E. faecalis to clindamycin and erythromycin were all more than 60％，and the
sensitivity to other antibiotics was more than 60％. CONCLUSIONS The VRE infection strains in our hospital are mainly natural
drug-resistant bacteria such as E. gallinarum and E. casseliflavus，and vancomycin-resistant E. faecium is found. The resistance
rates of different strains to antibiotics are quite different.
KEYWORDS Enterococci；vancomycin；clinical distribution；drug resistance

肠球菌（Enterococcus）广泛存在于土壤、水源等自
＊硕士研究生。研究方向：细菌及抗菌药物。E-mail：792570109@
然界中，是肠道正常菌群的组成部分之一，是除葡萄球
qq.com
# 通信作者：副教授，硕士生导师，博士。研究方向：耐药细菌及 菌（Staphylococcus）外最常见的导致院内感染的革兰氏
[1]
耐药机制。E-mail：zwmcyc@sina.com 阳性球菌 。该菌为兼性厌氧菌，具有耐盐、耐高温、生

中国药房 2022年第33卷第10期 China Pharmacy 2022 Vol. 33 No. 10 ·1253 ·