| With the development of medical technology and the invasive operation in diagnostictechniques,Enterococcus which was originally a normal intestinal flora have gradually becomean important pathogen of opportunistic infections.In recent years,domestic and foreign reports ondetection of bacterial resistance showed that Enterococcus infections caused by a gradualincrease had become the primary pathogens of nosocomial infections.While using antibiotics totreat bacterial infections,bacterial resistance to antibiotics is also increasing.Along withresistance from enterococci gradually from a single antibiotic resistance changed into multipledrug resistance.It’s clinically an important method to treat enterococcal infections that usedaminoglycoside antibiotics combined with the drug used in the cell wall of bacteria.But since1979,Evance firstly reported high resistance to gentamicin(HLGR)enterococci,Enterococcushigh concentrations of aminoglycoside antibiotics resistance(HLAR)gradually increased,anddomestic research showed that the HLAR intestinal ball incidence has been as high as 73.9%.Toreduce the antibiotic selection pressure,resistance mechanisms of Enterococcus had become apriority.Zhejiang,Anhui,Henan and other places in China had enterococci on HLAR from clinicaldistribution analysis of drug resistance to a more indepth reports of the detection of drugresistance genes,molecular epidemiology studies.Overall,HLAR Enterococcus in hospitalinfection was an upward trend,to a large extent to the clinical use of drugs makes it difficult.Tothis end,we analyzed and studied the resistance change,resistance gene detection et al of clinicalisolates of enterococci which had found in Peace hospital affiliated to Changzhi Medical CollegeShanxi Province.Then we can provide the basis for the clinical treatment of infection by the inthe region of Enterococcus hospital.Part AA Study on Enterococcus Hospital Infection and Drug ResistanceObjective:To understand the variation of clinical distribution and drug resistance ofenterococci,and to provide the basis for the clinical drugs use.Methods:Take the VITEK2 COMPACT automatic microbiological analytical system to do drugtests and identify 180 strains of enterococci separated from clinical samples from May 2007 toApril 2010,do the statistical analysis with WHONET5.4 statistical software.Results:Enterococci detection rate increases by 3.05%,3.14% and 4.34% respectively withinthree years.Among all the 180 strains enterococci,there are 116 strains enterococcus faeciumwhich occupy 64.4%,there are 50 strains enterococcus faecalis which occupy 27.80%,and there are 14 strains of other enterococci which accounts for 7.80%.Most of the samples are urinespecimens;it takes up 43.33%,both sputum and secretions occupy a proportion of more than10%.In the clinical distribution,nephrology department includes 32 strains which are17.78%,general surgery includes 26 strains which are 14.44%,and urology surgery 24 strainswhich are 13.33%.The susceptibility results of the commonly used antibiotics to enterococcishowed the lowest susceptibility rate is vancomycin (0%),it is followed by teicoplanin(0.92%),linezolid (2.49%),etc.Erythromycin resistance was the strongest(94.81%).Enterococcusfaecium’s drug resistance to several antibiotics of enterococci was higher than enterococcusfaecalis.Enterococcus faecalis only resists tetracycline,quinoline/dalfopristin and other thanEnterococcus faecium.Different types of enterococci showed different drug resistance,and nostrains were found resistant to vancomycin.In three years,the drug resistance of enterococcusfaecium and enterococcus faecalis to tetracycline increased year by year,and the resistance rate toother antibiotics also varied.Conclusion:As an important hospital pathogen,Enterococci’separation rate increasedgradually,its multiple drug resistance is becoming more serious,and resistances of differentstrains vary significantly,thus clinical medicine should be taken with consideration to drugsusceptibility results in the rational selection of antibiotics. Part BThe Distribution Antibiotic Resistance Characteristics and Resistance Genesof HLAR EnterocciObjective:To understand the distribution and antibiotic resistance characteristics of HLARenterococci in Changzhi area Shanxi Province, and resistance genes were detected and analyzed.Methods:1.We use the WHONET5.4 and Spss13.0 statistical software to analyze clinically thedistribution and drug resistance characteristics of 59 HLAR;2.Amplification ofaminoglycoside-modifying enzyme gene were amplified that were aac（6′)-Ie-aph(2′′)-Ia,aph（2′′）-Ib,ant (6′)-I and ant（3′′）-I through PCR.3.The positive gene products were sequenced inGenbank and the target gene to compare and analyze.Results:1.There are Enterococcus faecium 42 (71.2%) and Enterococcus faecalis 17 (28.8%) in59 HLAR Enterococcus.There are 29 (49.2%),18 (30.5%),4(6.8%),8(13.6%) enterococci whichwere followed by sputum ,blood,pus and other specimens.These specimens are from theDepartment of Urology, 8 (13.6%), general surgery 7 (11.8%),as well as other sections of the 38(64.4%).2,There are 59 strains of high-level gentamicin and streptomycin-resistant strains which composed by 48 of aac(6’)-of Ie-aph(3’)-Ia positive gene,31 of ant(6’)-I positive gene, no aph(2’’)-Ib and ant (3’)-I gene positive.3.Sequence analysis of the results: aac(6’)-of Ie-aph(3’)-Iagene positive product sequence in Genebank the Blast analysis,the homology was 100%.ant(6’’)-I gene positive product of the sequence by matching pairs of homology in more than96%.Part of the gene base deletion or insertion of amino acid sequence had no effect.Conclusion:The region HLAR enterococci invasive operation opportunities more departmentsmore likely to cause opportunistic infections to cause great concern.HLAR enterococcimodifying enzyme genotype to aac(6’)-Ie-aph(3’)-Ia and ant(6’)-I.Although the abnormal gene isnot found,HLAR enterococci and the HLGR+HLSR proportion is seriously highest drugresistance.We suggest that we should reasonably choose clinically antibiotics by susceptibility... |
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