胆道感染的病原菌组成及药敏变化分析  

Dynamics of Bacteria and Drug Sensitivity Test in Biliary Tract Infections

作　　者：孟泽武[1] 陈燕凌[2] 唐南洪[1] 

机构地区：[1]福建医科大学附属协和医院肝胆研究所,福建福州350001 [2]福建医科大学附属协和医院肝胆外科,福建福州350001

出　　处：《中华医院感染学杂志》2008年第1期117-118,共2页Chinese Journal of Nosocomiology

基　　金：福建医科大学科学研究发展基金(FJGXY04018)

摘　　要：目的了解胆汁中感染病原菌菌群及其对抗菌药物的敏感性变化。方法取2002年1月-2005年12月,在福建医科大学附属协和医院确诊为胆道感染行内镜鼻胆管引流或外科手术采集的胆汁标本进行培养、菌种鉴定及药敏分析。结果2002-2005年革兰阴性菌在胆道感染中所占的比率下降(r=-0.983,P<0.05),而革兰阳性菌(r=0.982,P<0.05)及真菌(r=0.971,P<0.05)的比率上升;革兰阴性菌中主要为大肠埃希菌(r=-0.992,P<0.01)、摩氏摩根菌(r=-0.970,P<0.05)所占的比率下降,革兰阳性菌中主要为肠球菌属所占的比率上升(r=0.981,P<0.05),真菌中主要为假丝酵母菌属所占的比率上升(r=0.976,P<0.05);大肠埃希菌对大部分抗菌药物的耐药率随着超广谱β-内酰胺酶(ESBLs)检测阳性率改变而改变。结论4年来胆道感染菌群变迁,临床应用广泛的抗菌药物耐药率增加,ESBLs为病原菌耐药主要因素。OBJECTIVE To investigate dynamics of bacteria in biliary tract infections and their sensitivity to antibiotics. METHODS All bile specimens were collected from surely patients with biliary infection by endoscopic nasobiliary drainage or surgery in Union Hospital affiliated to Fujian Medical University, from Jan 2002 to Dec 2005. All specimens were cultured, and followed by bacterial identification and antibiotics resistance assay. RESULTS The ratio of Gram-negative bacteria in all bacteria of biliary tract infections was decreased （ r = -0. 983 ,P〈0.05）, in contrary to the increasing ratio of Gram-positive bacteria （r= 0. 982, P〈0.05） and fungi （r= 0. 971, P〈 0. 05）. The main pathogens of decreased Gram-negative bacteria were Escherichia coli （r=- 0. 992, P〈0.01） and Morganella morganii （r=- 0. 970, P〈 0. 05）, the main pathogens of increased Grampositive bacteria were Enterococcus （r=0. 981, P〈0.05） and that of fungi were Candida （r= 0. 976,P〈0.05）. The Enterococcus had a high resistance to the most of antibiotics in recent year from the drug sensitivity test, and the resistance to antibiotics of E. coli was changed by the detection ratio of ESBLs. CONCLUSIONS The bacterial species in the bile are dynamically changed and their resistance to antibiotics is increasing in recent four years, the ESBLs are one of the main factors of the resistance to antibiotics.

关 键 词：胆汁 病原菌 药物敏感试验 超广谱Β-内酰胺酶 

分 类 号：R378.2[医药卫生—病原生物学]