一家三级护理医院中来自各种临床样本的肠球菌种类的患病率及特征
The prevalence and the characterization of the enterococcus species from various clinical samples in a tertiary care hospital.
作者信息
Sreeja S, Babu P R Sreenivasa, Prathab A G
机构信息
Assiatant Professor, Department of Microbiology, MS Ramaiah Medical College, MSR Nagar, MSRIT Post, Bangalore-54 (India).
出版信息
J Clin Diagn Res. 2012 Nov;6(9):1486-8. doi: 10.7860/JCDR/2012/4560.2539.
BACKGROUND
Enterococci form a part of the normal flora of the intestinal tract, the oral cavity, and the vagina, but in recent times, they have become emerging nosocomial pathogens. Their increasing importance is largely due to their resistance to antimicrobials. The therapeutic failures in enterococcal infections are mainly due to the intrinsic as well as transferable drug resistance. The main aim of our study was to estimate the prevalence of the Enterococcus infection and to determine the antibiogram in a tertiary care hospital.
METHOD
Enterococcus was isolated from a total of 5555 clinical samples like urine , pus, tissue, blood and body fluids during the period from January to December 2008. The isolates were speciated by using conventional biochemical tests (Facklam and Collins). The antibiotic susceptibility testing was done by the Kirby Bauer disc diffusion method. Confirmation of vancomycin susceptibility was done by the Epsilometer test (E test) to determine the Minimum Inhibitory Concentration (MIC).
RESULT
From various clinical samples, 128 Enterococcus species were isolated in a period of one year and the rate of the infection was estimated to be 2.3%. Among the isolates, those of Enterococcus faecalis (E.faecalis) were 97(76%) and the remaining 31(24%) were of Enterococcus faecium (E.faecium). The maximum number of isolates were from pus 55(43%), followed by the isolates from urine 40(31%). The sensitivity pattern of these isolates showed an increased resistance to penicillin, ampicillin and ciprofloxacin. A High Level of Gentamicin Resistance (HLGR) was present in 60 (47% ) isolates of Enterococcus and 35(27%) isolates were intermediately sensitive to vancomycin by the Kirby Bauer disc diffusion method. All the intermediately sensitive isolates to vancomycin were further tested by the E test and they were found to be vancomycin sensitive.
CONCLUSION
Various studies have shown an increase in the rate of infection and the antibiotic resistance in the Enterococcus species. There is also a change in the pattern of the Enterococcus infection, with an increase in the isolation rate of E. faecium and other non faecalis Enterococcus species. The Kirby Bauer disc diffusion method is not an accurate method for detecting the Vancomycin Resistant Enterococci (VRE).
背景
肠球菌是肠道、口腔和阴道正常菌群的一部分，但近年来，它们已成为新出现的医院病原体。其重要性日益增加主要是由于它们对抗微生物药物具有抗性。肠球菌感染治疗失败主要归因于固有耐药性以及可转移的耐药性。我们研究的主要目的是估计一家三级护理医院中肠球菌感染的患病率并确定其抗菌谱。
方法
在2008年1月至12月期间，从总共5555份临床样本（如尿液、脓液、组织、血液和体液）中分离出肠球菌。使用传统生化试验（法克兰姆和柯林斯方法）对分离株进行鉴定。通过 Kirby Bauer 纸片扩散法进行抗生素敏感性测试。通过 E 试验（Etest）确认万古霉素敏感性以确定最低抑菌浓度（MIC）。
结果
在一年时间里，从各种临床样本中分离出128株肠球菌，感染率估计为2.3%。在分离株中，粪肠球菌（E.faecalis）有97株（76%），其余31株（24%）为屎肠球菌（E.faecium）。分离株数量最多的来自脓液，有55株（43%），其次是尿液中的分离株，有40株（31%）。这些分离株的敏感性模式显示对青霉素、氨苄西林和环丙沙星的耐药性增加。60株（47%）肠球菌分离株存在高水平庆大霉素耐药（HLGR），通过 Kirby Bauer 纸片扩散法，35株（约27%）分离株对万古霉素中度敏感。所有对万古霉素中度敏感的分离株均通过 E 试验进一步检测，结果发现它们对万古霉素敏感。
结论
各种研究表明肠球菌属的感染率和抗生素耐药性有所增加。肠球菌感染模式也发生了变化，屎肠球菌和其他非粪肠球菌属的分离率有所增加。Kirby Bauer 纸片扩散法不是检测耐万古霉素肠球菌（VRE）的准确方法。
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