Trends in antimicrobial resistance among clinical isolates of enterococci in a Brazilian tertiary hospital: a 4-year study
Trends in antimicrobial resistance among clinical isolates of enterococci in a Brazilian tertiary hospital: a 4-year study
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DOI：
10.1590/s0037-86822011005000009
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发表时间：
2011-04-01
影响因子：
2
通讯作者：
Oliveira, Adriana Gonçalves de
中科院分区：
文献类型：
--
作者：
Conceição, Natália;Oliveira, Cristina da Cunha Hueb Barata de;Oliveira, Adriana Gonçalves de
导言：在过去的二十年里，肠球菌属的成员已经成为世界范围内重要的医院病原体。本研究前瞻性分析了2006-2009年巴西某三级医院肠球菌临床分离株的菌种分布及耐药趋势。方法：采用常规生化试验鉴定肠球菌菌种。按照临床和实验室标准协会（CLSI）的规定，采用纸片扩散法进行抗菌药物敏感性分析。还进行了万古霉素筛选试验。采用肉汤稀释法测定万古霉素的最低抑菌浓度。采用分子分析方法确定万古霉素耐药肠球菌（VRE）的种类和基因型。结果：共检出非重复性肠球菌324株，其中粪肠球菌87%，粪肠球菌10.8%。每1000名入院患者中粪肠杆菌的发病率从2006年的0.3例显著增加到2009年的2.3例（p < 0.001）。VRE率也随着时间的推移从2.5%增加到15.5% （p < 0.001）。所有VRE均表达对万古霉素的高水平耐药（MIC >= 256 μ g/mL），并携带vanA基因。大部分VRE（89.5%）属于粪肠杆菌，主要对氨苄西林和喹诺酮类药物耐药。总体而言，2006-2009年氨苄西林耐药率从2.5%显著增加到21.4%。庆大霉素、氯霉素、四环素和红霉素的耐药率随着时间的推移显著下降，尽管它们仍然很高。喹诺酮类药物耐药率高，且随时间变化不显著。结论：获得的数据显示，对氨苄西林和万古霉素耐药的粪肠杆菌的发病率有明显增加的趋势。
Introduction: In the past two decades members of the genus Enterococcus have emerged as important nosocomial pathogens worldwide. This study prospectively analyzed the distribution of species and trends in antimicrobial resistance among clinical isolates of enterococci in a Brazilian tertiary hospital from 2006-2009. Methods: Enterococcal species were identified by conventional biochemical tests. The antimicrobial susceptibility profile was performed by disk diffusion in accordance with the Clinical and Laboratory Standards Institute (CLSI). A screening test for vancomycin was also performed. Minimal inhibitory concentration (MIC) for vancomycin was determined using the broth dilution method. Molecular assays were used to confirm speciation and genotype of vancomycin-resistant enterococci (VRE). Results: A total of 324 non-repetitive enterococcal isolates were recovered, of which 87% were E. faecalis and 10.8% E. faecium. The incidence of E. faecium per 1,000 admissions increased significantly (p < 0.001) from 0.3 in 2006 to 2.3 in 2009. The VRE rate also increased over time from 2.5% to 15.5% (p < 0.001). All VRE expressed high-level resistance to vancomycin (MIC >= 256 mu g/mL) and harbored vanA genes. The majority (89.5%) of VRE belonged to E. faecium species, which were characteristically resistant to ampicillin and quinolones. Overall, ampicillin resistance rate increased significantly from 2.5% to 21.4% from 2006-2009. Resistance rates for gentamicin, chloramphenicol, tetracycline, and erythromycin significantly decreased over time, although they remained high. Quinolones resistance rates were high and did not change significantly over time. Conclusions: The data obtained show a significant increasing trend in the incidence of E. faecium resistant to ampicillin and vancomycin.