新生儿重症监护室患儿肠道内定植的大肠埃希菌和肠球菌耐药分析

李小芳; 刘尊杰; 陈霞; 李娟; 崔志刚; 阚飙; 马建荣; 崔晶花

Abstract

李小芳,刘尊杰,陈霞,李娟,崔志刚,阚飙,马建荣,崔晶花.新生儿重症监护室患儿肠道内定植的大肠埃希菌和肠球菌耐药分析[J].Chinese journal of Epidemiology,2017,38(9):1259-1262

新生儿重症监护室患儿肠道内定植的大肠埃希菌和肠球菌耐药分析

Study on antibiotic resistance of Escherichia coli and Enterococcus colonized in intestine of neonates from neonatal intensive care unit

Received:January 11, 2017

DOI：10.3760/cma.j.issn.0254-6450.2017.09.023

KeyWord: 大肠埃希菌肠球菌新生儿重症监护室耐药性

English Key Word: Escherichia coli Enterococcus Neonatal intensive care unit Antibiotic resistance

FundProject:国家自然科学基金青年基金（81501799）

Author Name	Affiliation	E-mail
Li Xiaofang	National Institute for Communicable Disease Control and Prevention and State Key Laboratory for Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Liu Zunjie	Beijing Maternity and Child Care, Affiliated Beijing Maternity Hospital, Capital University of Medical Sciences, Beijing 100026, China
Chen Xia	National Institute for Communicable Disease Control and Prevention and State Key Laboratory for Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Li Juan	National Institute for Communicable Disease Control and Prevention and State Key Laboratory for Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Cui Zhigang	National Institute for Communicable Disease Control and Prevention and State Key Laboratory for Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Kan Biao	National Institute for Communicable Disease Control and Prevention and State Key Laboratory for Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Ma Jianrong	Beijing Maternity and Child Care, Affiliated Beijing Maternity Hospital, Capital University of Medical Sciences, Beijing 100026, China
Cui Jinghua	National Institute for Communicable Disease Control and Prevention and State Key Laboratory for Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing 102206, China	cuijinghua@icdc.cn

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Abstract:

目的了解新生儿重症监护室（NICU）患儿肠道菌定植和耐药情况，为临床用药及合理治疗提供依据。方法 2014年5月至2015年5月对北京妇幼保健院NICU新生儿采集的572份粪便样本进行肠道菌分离培养，采用VITEK-2系统进行菌株鉴定和抗生素敏感性检测，并对耐药情况进行统计分析。结果分离得到328株大肠埃希菌和243株肠球菌。选取的199株大肠埃希菌对亚胺培南、厄他培南、阿米卡星、呋喃妥因较敏感（耐药率为0.50%~3.52%）；对氨苄西林、四环素、复方甲基异恶唑、头孢唑啉耐药率较高（耐药率为54.27%~84.92%），未发现对美罗培南耐药菌株；产ESBL的菌株占45%；多重耐药情况统计结果显示对4类抗生素耐药性的菌株数量最多（34.6%）；有3株大肠埃希菌对7类抗生素表现耐药性。肠球菌对链阳霉素、呋喃妥因、链霉素较敏感（耐药率为0.41%~4.53%）；对氨苄西林、青霉素、环丙沙星、四环素、庆大霉素、红霉素耐药率较高（耐药率为70.78%~91.77%），未发现对替加环素、万古霉素、利奈唑胺耐药的肠球菌；多重耐药情况统计结果显示，对5类抗生素表现耐药性的菌株数量最多（86.5%）。结论 NICU新生儿肠道定植的大肠埃希菌和肠球菌对抗生素耐药情况较严重，呈现多重耐药性，临床用药应结合药敏实验结果，合理选择抗菌药物。

English Abstract:

Objective To understand the antibiotic resistance of bacteria colonized in intestine of the neonates from neonatal intensive care unit (NICU) and provide evidence to guide clinical antibiotic treatment. Methods From May, 2014 to May, 2015, a total of 572 stool samples were collected from the neonates of NICU in our hospital. Escherichia coli and Enterococcus were detected with VITEK-2 system. Results A total of 328 strains of E. coli and 243 strains of Enterococcus were isolated respectively in this study. The 199 strains of E. coli selected for drug susceptibility test showed lower resistant rate to imipenem, ertapenem, amikacin, nitrofurantoin, ranging from 0.50% to 3.52% and showed higher resistant rate to ampicillin, tetracycline, trimethoprim/sulfamethoxazole and cefazolin, ranging from 54.27% to 84.92%. No meropenem resistant strainsere were found. The percentage of ESBLs production strains was 45%. The multi drug resistance test showed that 34.6% of the strains were resistant to four antibiotics. Three strains were resistant to seven antibiotics. The 243 strains of Enterococcus showed lower resistant rate to quinupristin/dalfopristin, nitrofurantoin, streptomycin, ranging from 0.41% to 4.53% and showed higher resistant rate to ampicillin, benzylpenicillin, ciprofloxacin, tetracycline, gentamicin and erythromycin, ranging from 70.78% to 91.77%. No strains which were resistant to tigecycline, vancomycin, rina thiazole amine/ketone were found. The multi drug-resistance test showed that 86.5% of the strains were resistant to five antibiotics. Conclusions According to the analysis of the 199 strains of E. coli and 243 strains of Enterococcus isolated from the neonates, we found that the resistance of intestinal bacteria in the neonates was very serious, showing multi drug resistance. It is necessary to use antibiotics according to the drug susceptibility test results in clinical treatment.

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