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In Vitro Activity of Sixteen Drugs Against Staphylococcus Aureus, Enterococcus Faecalis and Enterococcus Faecium: A Multicentre Cross-sectional Study in China
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摘要:
目的 评估16种常用抗菌药物对临床分离的金黄色葡萄球菌、粪肠球菌、屎肠球菌的体外抗菌活性。 方法 收集2019年1月1日—12月31日全国18个省、24家医院临床分离的金黄色葡萄球菌、粪肠球菌、屎肠球菌。采用自动化仪器对菌株进行体外药敏试验，并采用WHONET 5.6软件统计菌株对万古霉素、去甲万古霉素、夫西地酸、利奈唑胺等16种抗菌药物的药敏结果。 结果 共收集金黄色葡萄球菌255株、粪肠球菌117株、屎肠球菌114株。标本类型以血液最常见(22.2%，108/486)，其次为尿液(18.9%，82/486)。药敏试验结果显示，万古霉素、去甲万古霉素、利奈唑胺、替考拉宁对金黄色葡萄球菌、粪肠球菌、屎肠球菌均保持了良好的抗菌活性。其中，金黄色葡萄球菌和粪肠球菌对万古霉素、替考拉宁全部敏感；屎肠球菌对万古霉素和替考拉宁的耐药率分别为4.4%和2.6%；金黄色葡萄球菌、屎肠球菌、粪肠球菌对利奈唑胺的耐药率分别为0、0和4.3%。去甲万古霉素与万古霉素对金黄色葡萄球菌、屎肠球菌、粪肠球菌均具有相似的抗菌活性，半数最低抑菌浓度(50% minimum inhibitory concentration, MIC50)均为1 mg/L，90%最低抑菌浓度(90% minimum inhibitory concentration, MIC90)均为2 mg/L。在金黄色葡萄球菌中，甲氧西林耐药金黄色葡萄球菌的检出率为35.7%，其对夫西地酸的耐药率为13.2%，而甲氧西林敏感金黄色葡萄球菌对夫西地酸的耐药率仅为3.0%。 结论 16种抗菌药物对金黄色葡萄球菌、粪肠球菌、屎肠球菌的抗菌活性存在较大差异，该数据为抗菌药物的合理使用提供了一定参考。 Abstract:Objective To evaluate the in vitro antimicrobial activities of 16 common agents against Staphylococcus aureus, Enterococcus faecium and Enterococcus faecalis to provide data for the rational clinical use of drugs. Methods From 1st January to 31st December in 2019, Staphylococcus aureus, Enterococcus faecium and Enterococcus faecalis were collected from 24 hospitals in 18 provinces in China. Antimicrobial susceptibility testing was conducted by automated instrumentation method, and WHONET 5.6 software was used to calculate the drug sensitivity results of the strains to 16 antibacterial drugs including vancomycin, norvancomycin, fusidic acid and linezolid. Results A total of 255 strains of Staphylococcus aureus, 117 strains of Enterococcus faecalis and 114 strains of Enterococcus faecium were collected. Blood was the most common specimen type (22.2%, 108/486), followed by urine (18.9%, 82/486). According to the drug sensitivity results, vancomycin, norvancomycin, linezolid and teicoplanin maintained high activity to all strains. All Staphylococcus aureus and Enterococcus faecalis were sensitive to vancomycin and teicoplanin, while the resistance rates of vancomycin and teicoplanin against Enterococcus faecium were 4.4% and 2.6%, respectively. The resistance rates of linezolid against Staphylococcus aureus, Eenterococcus faecium and Eenterococcus fascalis were 0, 0 and 4.3%, respectively. Norvancomycin and vancomycin showed similar antibacterial activity against Staphylococcus aureus, Enterococcus faecium, and Enterococcus faecalis, with 50% minimum inhibitory concentration (MIC50) of 1 mg/L, and MIC90 of 2 mg/L. The isolation rate of methicillin-resistant Staphylococcus aureas(MRSA) was 35.7%, with 13.2% resistance to fusidic acid and 3.0% in methicillin-susceptible Staphylococcus aureas. Conclusions The activity of the 16 antimicro-bial drugs against Staphylococcus aureus, Enterococcus faecium and Enterococcus faecalis varied considerably. The data will provide reference for the rational use of antimicrobial drugs. -
Key words:
- Staphylococcus aureus /
- Enterococcus faecium /
- Enterococcus faecalis /
- vancomycin /
- norvancomycin /
- fusidic acid /
- linezolid
作者贡献：吴云负责研究设计及论文撰写；陈家炜负责数据分析；王瞳、李进、张戈、康巍、张京家负责菌株鉴定及药敏数据收集；刘亚丽、徐英春、孙宏莉负责论文审核及修订。利益冲突：所有作者均声明不存在利益冲突 -
表 1 486株革兰阳性球菌菌种分布情况[n(%)]
指标 金黄色葡萄球菌(n=255) 粪肠球菌(n=117) 屎肠球菌(n=114) 患者所在科室 ICU(n=52) 35(67.3) 13(25.0) 4(7.7) 非ICU(n=434) 220(50.7) 104(24.0) 110(25.3) 患者性别 女性(n=191) 101(52.9) 43(22.5) 47(24.6) 男性(n=295) 154(52.2) 74(25.1) 67(22.7) 患者所属群体 新生儿(0~＜2岁，n=47) 28(59.6) 9(19.1) 10(21.3) 青少年(2~＜18岁，n=33) 26(78.8) 4(12.1) 3(9.1) 成人(18~＜60，n=247) 126(51.0) 68(27.5) 53(21.5) 老年人(≥60岁，n=159) 75(47.2) 36(22.6) 48(30.2) 患者所属地区 华北(n=87) 46(52.9) 0(0) 41(47.1) 西北(n=112) 78(69.6) 14(12.5) 20(17.9) 东北(n=64) 44(68.7) 0(0) 20(31.3) 华中(n=87) 0(0) 60(69.0) 27(31.0) 华东(n=28) 20(71.4) 2(7.1) 6(21.4) 华南(n=60) 19(31.7) 41(68.3) 0(0) 西南(n=48) 48(100) 0(0) 0(0) 
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表 2 16种抗菌药物对金黄色葡萄球菌、粪肠球菌、屎肠球菌的体外抗菌活性
抗菌药物 MRSA (n=91) MSSA(n=164) 粪肠球菌(n=117) 屎肠球菌(n=114) 耐药率(%) 敏感率(%) 耐药率(%) 敏感率(%) 耐药率(%) 敏感率(%) 耐药率(%) 敏感率(%) 青霉素 100 0 86.0 14.0 5.1 94.9 95.6 4.4 苯唑西林 100 0 0 100 NA NA NA NA 头孢罗膦 0 100 0 100 NA NA NA NA 红霉素 73.6 23.1 48.2 50.6 65.8 3.4 90.4 6.1 克林霉素 56.0 35.2 11.6 84.1 NA NA NA NA 万古霉素 0 100 0 100 0.0 98.3 4.4 95.6 去甲万古霉素 0§ 100§ 0§ 100§ 0§ 99.2§ 5.3§ 94.7§ 达托霉素 NA 92.3 NA 95.7 2.6 94.9 12.3 87.7* 利奈唑胺 0 100 0 100 4.3 88.9 0 100 替考拉宁 0 100 0 100 0 100* 2.6 97.4 莫西沙星 20.9 74.7 6.1 92.7 42.7 41.0 93.4 3.7 利福平 7.7 87.9 0.6 99.4 65.0 13.7 44.7 35.1 夫西地酸 13.2 86.8 3.0 97.0 NA NA NA NA 左氧氟沙星 22.0 74.7 7.3 92.1 35.0 49.6 89.5 6.1 呋喃妥因 NA NA NA NA 0.9 97.4 52.6 12.3 庆大霉素 16.5 80.2 11.6 87.8 NA NA NA NA 庆大霉素(高浓度) NA NA NA NA 30.7 69.3 36.8 63.2 MRSA：甲氧西林耐药金黄色葡萄球菌；MSSA: 甲氧西林敏感金黄色葡萄球菌；NA：不适用；§去甲万古霉素参考万古霉素的临床折点；*剂量依赖敏感
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