不同疾病胆道感染患者的胆汁菌群分布及影响因素分析  

Analysis of distribution and influencing factors of bile pathogens in patients with biliary tract infections caused by different diseases

作　　者：郑秀玲[1] 江平[2] 廖铂[2] 程志祥[2] ZHENG Xiuling;JIANG Ping;LIAO Bo;CHEN Zhixiang(Dept.of Sterile Supply Center,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China;Dept.of Hepatobiliary and Pancreatic Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China)

机构地区：[1]武汉大学中南医院消毒供应中心,湖北武汉430071 [2]武汉大学中南医院肝胆胰外科,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2020年第5期786-790,共5页Medical Journal of Wuhan University

摘　　要：目的:观察胆道感染患者胆汁病原菌的分布特征、培养阳性率及其对抗菌药物的敏感性以及不同疾病、不同操作方法胆道细菌分布情况,指导临床合理应用抗菌药物。方法:选取2016年1月-2018年12月武汉大学中南医院肝胆胰外科104例胆汁培养阳性标本,所有胆汁标本均行普通细菌、厌氧菌及真菌培养,分析药敏试验结果,并对胆汁取样方法、疾病类型进行分析比较。结果:104例患者检出131病原菌株,其中23例患者为混合感染,且此23例患者中4例存在3种病原菌感染。其中革兰阴性菌84株,占64.1%;革兰阳性菌44株,占33.6%;真菌3株,2.3%;排名前5位的病原菌依次为大肠埃希菌、屎肠球菌、肺炎克雷伯杆菌、铜绿假单胞菌、粪肠球菌。革兰阴性菌对于亚胺培南药物、氨苄西林耐药率分别为最低及最高,对其他抗菌类药物的耐药率也较高。革兰阳性菌除粪肠球菌耐药较低外,其它主要细菌对常用抗菌药物耐药率较高,但均对万古霉素、替加环素及利奈唑胺敏感。不同手术方式ERCP、PTCD、PTGD以及胆管探查手术胆汁细菌分布及混合细菌感染无显著差异。良性病变与恶性肿瘤主要细菌分布及混合细菌感染无显著差异。结论:胆道感染以革兰阴性菌为主,不同病变胆道感染细菌分布相似,不同手术方式胆道感染细菌分布无明显差别,胆道感染可以经验性用药,但耐药率较高。Objective:To observe the distribution characteristics of bile pathogens in patients with biliary in-fection,the positive rate of culture and the sensitivity of antibacterial drugs,as well as the distribution of biliary pathogenic strains in different diseases and different operation methods,to guide the rational use of antimicrobial agents in clinic.Methods:A total of 104 cases of bile culture positive samples were selected in the department of hepatobiliary and pancreatic surgery of Zhongnan Hospital of Wu-han University from January 2016 to December 2018,all the bile samples were cultured with common bacteria,anaerobes,and fungi.The results of drug sensitivity test were analyzed and compared by different bile sampling methods and disease types.Results:A total of 131 pathogenic strains were de-tected in 104 patients,23 of them were mixed infections,and 4 of these 23 patients had three kinds of pathogen infections.The pathogenic bacteria were Gram-negative strains 84(64.1%),Gram-positive strains 44(33.6%),and fungal 3(2.3%).The dominant bacteria were Escherichia coli,Enterococcus faecalis,Klebsiella pneumoniae,Pseudomonas aeruginosa,and Enterococcus faecalis.The resis-tance rate of Gram-negative strains to imipenem was the lowest,while the rate to ampicillin was the highest.The resistance rates to other antimicrobial agents were also higher.The resistance rate of Gram-positive strains were low except Enterococcus faecalis,the other major Gram-positive strains were also highly resistant to commonly used antimicrobial,but they were sensitive to vancomycin,tegacycline,and linazolamide.There were no significant differences among different surgical proce-dures as ERCP,PTCD,PTGD,and bile duct exploration in the distribution of bile bacteria and mixed infections,and there were no significant difference in the main bacterial distribution and mixed infection between benign lesions and malignant tumors.Conclusion:Gram-negative strains were the commonest pathogens in biliary tract disease,but no significant difference in th

关 键 词：胆道感染 病原菌 影响因素 

分 类 号：R657.4[医药卫生—外科学]