156例胆道感染病原菌分布及其对抗菌剂敏感性分析  

Pathogenic bacteria and drug-sensitivity analysis of 156 cases of infection of biliary tract

作　　者：肖秀红[1] 徐凤琴[1] 陈伯宁[1] 陈丽容[1] 

机构地区：[1]中山大学孙逸仙纪念医院医院感染管理办公室,广州510120

出　　处：《国际检验医学杂志》2011年第17期1950-1952,1955,共4页International Journal of Laboratory Medicine

摘　　要：目的了解胆道感染的病原菌分布及其对抗菌剂敏感性的变化,为临床选择用药提供参考。方法收集2007年1月至2010年12月培养阳性的156例胆汁标本238株临床分离株中病原菌及药敏结果分为社区获得性胆道感染组和医院获得性胆道感染组,利用WHONET软件进行数据分析。结果 238株临床分离菌株中包含35种细菌,其中革兰阴性菌168株,占70.6%;革兰阳性菌70株,占29.4%。分离量排列前5位的细菌依次为大肠埃希菌(28.2%)、粪肠球菌(12.6%)、铜绿假单胞菌(12.2%)、肺炎克雷伯菌(11.3%)、屎肠球菌(6.3%)。医院获得性胆道感染组混合感染的比例(39.6%)明显高于社区获得性感染组(28.7%)。革兰阴性菌对青霉素类、头孢类、喹诺酮类耐药性明显增加,对亚胺培南、美罗培南敏感性仍较高;革兰阳性菌对克林霉素、复方新诺明、利福平、红霉素、四环素的耐药性明显增加,对喹诺酮类、万古霉素、替考拉宁敏感性仍较高。医院获得性感染组大肠埃希菌产ESBLs的比率明显高于社区获得性感染组。结论胆道感染病原菌谱不断改变,细菌的种类和耐药性在增加;医院获得性胆道感染不仅在感染类型、菌株种类上较社区获得性胆道感染复杂,而且细菌的耐药现象更严重。Objective To study the distribution of pathogenic bacteria in infection of biliary tract and the changes of their drug-sensitivity,to provide reference for clinical medication.Methods WHONET software was applied for analyzing the data of 238 strains of bacteria isolated from bile samples of 156 patients,positive with bile microorganism culture between January 2007 and December 2010,which were divided into community acquired infection group（CAI group） and hospital acquired infection group（HAI group）.Results There were 35 species among the 238 strains,including 168（70.6%） strains of Gram negative bacteria and 70（29.4%） of Gram positive.The five most common isolated strains were Escherichia coli（28.2%）,Enterococcus faecalis（12.6%）,Pseudomonas aeruginosa（12.2%）,Klebsiella pneumoniae（11.3%） and Enterococcus faecium（6.3%）.The proportion of mixed infection in HAI group（39.6%） was higher than that in CAI group（28.7%）.The Gram negative bacteria were obvious resistant to penicillins,cephalosporins and quinolones declined obviously,but sensitive to Imipenem and Meropenem.The Gram positive bacteria were significantly resistant to Clindamycin,Trimethoprim sulfamethoxazole,Rifampin,Erythromycin and Tetracycline,but sensitive to quinolones,vancomycin and teicoplanin.The proportion of ESBLs positive Escherichia coli in HAI group（61.1%） was higher than that in CAI group（28.6%）.Conclusion The types of bacteria in infection of biliary tract as well as their drug-resistance were increasing gradually.Hospital acquired biliary infection was not only more complex than community acquired biliary infection,but also had more serious drug-resistance.

关 键 词：胆道 感染 交叉感染 抗药性 细菌培养 

分 类 号：R446.5[医药卫生—诊断学]