目的 分析血流感染血培养常见的革兰阳性细菌分布及耐药性.方法 收集2012年10月-2015年9月武汉大学人民医院住院患者血液标本2 063份,分离革兰阳性菌株,并采用最低抑菌浓度(MIC)法进行药敏实验,按2015年美国临床实验标准委员会(NCCLS)指导原则的标准判定实验结果,计算出所测细菌对抗菌药物的耐药率(R)和敏感率(S).结果 血培养分离出革兰阳性菌1 051株,其中葡萄球菌754株(71.74%),肠球菌属96株(9.18%);耐甲氧西林金黄色葡萄球菌 (MRSA) 和耐甲氧西林凝固酶阴性葡萄球菌(MRSCN)的检出率分别为47.86%、65.00%;MRSA对阿米卡星、克林霉素、环丙沙星、利福平、庆大霉素、四环素、妥布霉素的耐药率均在55%以上,对红霉素的耐药率高达92%,但对复方新诺明、奎奴普丁/达福普汀保持着较好的敏感性;MRSCN对呋喃妥因、利奈唑胺、替考拉宁、万古霉素耐药率良好,为0~3%;屎肠球菌(EFM)耐药率普遍高于粪肠球菌(EFA).未发现对万古霉素、替考拉宁、利奈唑胺及氯霉素耐药的金黄色葡萄球菌,未发现对复方新诺明、奎奴普丁/达福普汀及氯霉素耐药的肠球菌属.结论 血流感染血培养中革兰阳性菌存在严重耐药,MRSA、MRSCN、屎肠球菌耐药情况尤为严峻,应加强耐药菌株的监测,合理用药.%Objective To provide the evidence for treatment of Gram-positive bacteria infection by investigating its distribution and drug resistance.Methods Antimicrobial susceptibility testing were carried out in the strains of Gram-positive bacteria with minimum inhibitory concentration (MIC) and the data were analyzed by WHONET 5.6 software according to CLSI 2015 Standards and calculated bacteria resistant rate (R%) and the sensitive rate (S%).Results A total of 1 051 clinical isolates of Gram-positive bacteria were collected including 754 strains of Staphylococci (71.74%),234 strains of Staphylococcus aureus(22.26%),96 strains of Enterococci (9.18%);The prevalence of Methicillin resistant S.aureus (MRSA) and Methicillin resistant coagulase negative S.aureus (MRCNS) were 47.86% and 65.00%,respectively.The drug resistance of MRSA was above 55% to AMK,CLI,CIP,RIF,GEN,TCY and TOB,above 92% to ERY,but maintained a good sensitivity to SET and QDA.MRSCN maintained a good sensitivity to NIT,TEC,LNZ and VAN about 0~3%;The resistance rate of Enterococcus faecium (EFM) was higher than that of Enterococcus faecalis (EFA).No resistance of Staphylococcus aureus to VAN,TEC,LNZ and CHL was found.No resistance of Enterococci to SET,QDA and CHL was found.Conclusion Gram-positive bacteria isolated from blood culture is highly resistant to drugs.The drug resistance of MRSA,MRSCN and EFM are very serious and its drug resistance monitoring should be strengthened in order to use drug rationally.
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