江丹英　林雪峰　王兵勇　陈静　应华永

[摘要] 目的 探討肠球菌属细菌临床分离情况及耐药性特征，为临床合理使用抗菌药物及控制感染提供依据。方法 回顾性分析1220株引起医院感染的肠球菌属细菌。采用Walk Away 96全自动微生物分析仪做菌株鉴定和药敏试验，采用MIC法筛检高水平氨基糖苷类耐药菌株，采用WHONET 5.6进行数据分析。 结果 共检出1220株肠球菌，其中粪肠球菌675株，占55.3%，屎肠球菌445株，占36.5%，肠球菌属细菌在各临床标本中的分布以尿液为主，占57.5%。屎肠球菌总体耐药率较高，其中对青霉素、氨苄西林、环丙沙星、左氧氟沙星的耐药率均超过90%，明显高于粪肠球菌对这4种抗菌药物的耐药率（<17%）。粪肠球菌对奎奴普丁/达福普汀的耐药率为100.0%，而屎肠球菌的耐药率为12.6%。两种细菌均未发现对万古霉素耐药菌株，但发现3株耐利奈唑胺的粪肠球菌。粪肠球菌对高水平庆大霉素耐药菌株和高水平链霉素耐药菌株的筛检率分别为54.1%和27.3%，而屎肠球菌的筛检率分别为58.2%和56.9%。 结论 肠球菌属细菌对常用抗菌药物的耐药情况不容乐观，监测肠球菌属的临床分布及耐药状况对临床治疗肠球菌属细菌感染具有重要的指导意义。

[关键词] 粪肠球菌；屎肠球菌；抗菌药物；耐药性

[中图分类号] R446.5 [文献标识码] B [文章编号] 1673-9701（2015）35-0099-04

[Abstract] Objective To investigate the clinical isolation situation and drug resistance features of enterococcal bacteria in order to provide reference for the clinical rational use of antibacterial agents and infection control. Methods A total of 1220 strains of enterococcal bacteria that induced hospital infection were analyzed retrospectively. Walk Away 96 automated microbial analyzer was used for strain identification and drug sensitive test. MIC was used for screening high-level aminoglycoside resistant strains. WHONET 5.6 was used for data analysis. Results A total of 1220 strains of enterococci were detected， including 675 strains of enterococci faecalis， accounting for 55.3%， and 445 strains of enterococci faecium， accounting for 36.5%. Enterococcal bacteria mainly distributed in clinical urine specimens， accounting for 57.5%. The total drug resistance rate of enterococci faecalis was high and the drug resistance rates to penicillin， ampicillin， ciprofloxacin and levofloxacin were all higher than 90%， which were significantly higher than those of the enterococci faecium （<17%）. The drug resistance rate of enterococci faecalis to quinupristin/dalfopristin was 100.0% and that of enterococci faecium was 12.6%. For both types of bacteria， no strain resistant to vancomycin was found， but 3 strains of enterococci faecalis were resistant to linezolid. The screening rates of enterococci faecalis for high-level gentamicin drug resistant strains and high-level streptomycin resistant strains were 54.1% and 27.3% respectively while those of enterococci faecium were 58.2% and 56.9% respectively. Conclusion The drug resistance situation of enterococcal bacteria to common antibacterial drugs is not optimistic， and the monitoring of clinical distribution and drug resistance situation of enterococcal bacteria is of important guiding significance to the clinical treatment of enterococcal bacterial infection.

[Key words] Enterococci faecalis； Enterococci faecium； Antimicrobial agents； Drug resistance

肠球菌属细菌主要由粪肠球菌和屎肠球菌组成，是人和动物肠道内的正常菌群，也是引起医院感染的重要条件致病菌，肠球菌异位寄生可以引起尿路感染、败血症、心内膜炎、创面及腹腔感染等[1]。由于粪肠球菌与屎肠球菌具有不同的耐药特征，并且近年来肠球菌的耐药性问题日趋严重，特别是耐万古霉素肠球菌（VRE）的出现，给临床对肠球菌感染的治疗造成极大的困难[2]。因此，对肠球菌属细菌的临床分布及耐药性进行动态监测，对指导临床合理用药十分重要。

1 材料与方法

1.1 材料

1.1.1 菌株来源 收集2010～2014年本院住院患者送检标本中检出的肠球菌1220株，剔除同一患者相同部位检出的重复菌株。标本类型包括尿液、血液、胆汁、脓液及创口分泌物、引流液等。……