阎东辉　 马纪平　 靳景图　

摘　要：目的　研究实验室中及时、准确地筛选出对高浓度氨基糖苷类药物(HLA)耐药和敏感的肠球菌，以便合理用药。方法　用含单一HLA(庆大霉素500μg/ml；链霉素2000μg/ml)琼脂稀释法和HLA(庆大霉素120μg/片；链霉素30μg/片)纸片扩散法对172株肠球菌做平行筛选试验，用纸片扩散法联合药敏试验和时间杀菌曲线试验对其验证。结果　稀释法和扩散法肠球菌(ENC)对高浓度庆大霉素耐药率分别为60.0％、59.3％，对高浓度链霉素耐药率两法均为61.1％。另外，172株肠球菌对青霉素、氨苄西林、万古霉素的耐药率分别为16.9％、14.0％、1.7％。80株肠球菌的β-内酰胺酶为阴性。结论　高含量纸片扩散法是临床实验室检测对高浓度氨基糖苷类耐药肠球菌的简便、可靠的方法。时间杀菌曲线试验的结果证实了两种方法完全符合。以上试验结果为临床医师联合用药治疗肠球菌感染提供了依据。
关键词：肠球菌属；氨基糖苷类；药敏试验
分类号：R516　文献标识码：A


Screening of high level aminnglycoside resistant enterococci and its therapy

YAN Donghui（Department of the Clinical Microbiology, Beijing Friendship Hospital Affiliated Capital Medical University, Beijing 100050, China）　
MA Jiping（Department of the Clinical Microbiology, Beijing Friendship Hospital Affiliated Capital Medical University, Beijing 100050, China）　
JIN Jingtu（Department of the Clinical Microbiology, Beijing Friendship Hospital Affiliated Capital Medical University, Beijing 100050, China）　


Abstract：Objective To establish the rational antibiotic treatment by accurate screening of highlevel aminoglycoside (HLA) resistant enterococci in clinical laboratory. Methods A single HLA gentamicin 500 μg/ml and streptomycin 200 μg/ml for agar dilution method, and gentamicin 120 μg/disk and streptomycin 300 μg/disk for disk diffusion method were used as parallel screening tests to detect high-level aminoglycoside resistance in 172 enterococci strains. Antibiotic time-kill test was performed to verify the accuracy and reliability of both methods. Results The resistant rates of the two methods for HLA gentamicin were 60.0％ and 59.3％, respectively. While for HLA streptomycin, both were 61.1%. In disk diffusion tests of 172 enterococci strains, the resistant rates for penicillin, ampicillin and vancomycin were 16.9 %,14.0%, and 1.7%, respectively. β-lactamase from 80 strains enterococci were all negative. Conclusion High-concentration aminoglycoside disk diffusion method is a simple, reliable method for screening the HLA resistant enterococci in clinical laboratory. The results can provide a rational base for physicians to treat enterococcal infections.
Keywords：Enterococcus; Aminoglycosides; Sensitivity test

作者单位：阎东辉（首都医科大学附属北京友谊医院，北京　100050）　
　　　　　马纪平（首都医科大学附属北京友谊医院，北京　100050）　
　　　　　靳景图（首都医科大学附属北京友谊医院，北京　100050）　

参考文献：

［1］Schaberg DR, Culver DH, Gaynes RP. Major trends in the microbial etiology of nosocomial infection. Am J Med, 1991, 91 (suppl3B) 72S-75S.
［2］Louie M, Simor AE, Szeto S, et al. Susceptibility testing of clinical isolates of Enterococcus faecium and Enterococcus faecalis. J Clin Microbiol, 1992, 30:41-45.
［3］Murray BE. The life and times of the enterococcus. Clin Microbiol Rev, 1990, 3:46-65.
［4］Meederski-Samoraj BD. High-level resistance to gentamicin in clinical isolates of enterococci. J Infect Dis, 1983, 147:751-757.
［5］Sahm DF, Torres C. Effects of medium and inoeulum variations on screening for high-level aminoglycoside resistance in Enteroeoccus faecalis. J Clin Microbiol, 1988, 26:250-256.
［6］娄永新,王金良,主编.实用临床细菌学检验进展第1版.天津：天津科技翻译出版公司,1993 268-271.
［7］马俊春.周红.对高浓度氨基糖甙类耐药菌株肠球菌的调查.中华医学检验杂志,1995,18:164-166.
［8］朱德妹.上海地区10所医院临床分离菌的耐药性监测.中华医学杂志,1992,72:596-599.
［9］Garden S, Swenson JM, Hill BC, et al. Antimicrobial susceptibility patterns of common and unusual species of enterococci causing infection in the United States. J Clin Microbiol, 1992, 30:2373-2378.




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