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目的:分析利奈唑胺(LZD)抗感染治疗过程中患者肠道LZD耐药肠球菌定植情况,为预防耐药肠球菌播散提供临床参考。方法:选取2016年8月至2016年12月深圳大学南山医院住院并使用LZD治疗患者15例,分析患者临床资料,采集用药前后各时间段患者粪便标本,采用选择性培养基筛选肠球菌及LZD耐药肠球菌,E.–test法检测肠球菌LZD药敏,采用聚合酶链反应技术(PCR)检测LZD耐药相关基因,包括23S rRNA基因V区、cfr、cfr(B)及optr A基因片段。结果:15例LZD治疗患者多数有长期慢性内科疾病病史或手术史,其使用LZD前均有抗生素使用史。肠道定植肠球菌检出率随着LZD用药时间延长而逐渐减少,其中2例患者在用药前检出LZD耐药肠球菌,随着用药1周肠道LZD耐药肠球菌亦分离不到,两例患者分离到的LZD耐药肠球菌均检测到optr A基因阳性。结论:LZD治疗患者肠道存在LZD耐药定植肠球菌分离阳性患者,LZD使用可以去除定植菌但定植菌是否具有耐药传播的临床意义有待明确。
Objective: To analyze the intestinal colonization of LZD resistant enterococci in patients with linezolid (LZD) anti-infective therapy and to provide a clinical reference for prevention of drug-resistant enterococci. Methods: From August 2016 to December 2016, 15 patients were admitted to Nanshan Hospital of Shenzhen University and treated with LZD. The clinical data of patients were collected. Stool specimens of patients at various time points before and after the treatment were collected. Enterococci and LZD Enterococcus faecalis and E.coli were used to detect the susceptibility of Enterococcus faecalis to LZD. The resistance genes of LZD including V region, cfr, cfr (B) and optr A gene of 23S rRNA gene were detected by polymerase chain reaction (PCR) Fragment. Results: Most of the 15 patients with LZD had a history of long-term chronic medical diseases or operation history. All patients had a history of antibiotic use before LZD. The detection rate of enterococci enterococci gradually decreased with the prolongation of LZD treatment time. Two patients were detected with LZD-resistant enterococci before the treatment, and the intestinal LZD-resistant enterococci were not separated after one week of treatment. The optr A gene was positive for LZD-resistant enterococci isolated from both patients. CONCLUSION: The clinical significance of LZD-resistant patients with LZD-resistant enterococcal enterococci isolates positive for LZD treatment can be used to remove the colonization bacteria, but whether the bacteria has the drug-resistant transmission needs to be clarified.