胆道感染患者的胆汁培养与抗生素选择  

Biliary germiculture and antibiotic selection in patients with biliary tract infection acquired during preoperative period

作　　者：朱震宇[1] 段伟宏[1] 孙建华[2] 李朝霞[3] 刘全达[1] 李华丽[1] 周宁新[1] 

机构地区：[1]解放军第二炮兵总医院肝胆胃肠病研究所,北京100088 [2]解放军第二炮兵总医院检验科,北京100088 [3]解放军第二炮兵总医院呼吸科,北京100088

出　　处：《中华保健医学杂志》2012年第3期215-218,共4页Chinese Journal of Health Care and Medicine

摘　　要：目的分析胆道感染患者胆汁中病原菌分布及其对抗生素的敏感性,为临床选择抗生素提供参考。方法将2009年8月至2011年8月在我院肝胆外科住院患者胆汁培养阳性的189株细菌及真菌的分布及药敏结果采用WHONET 5.3软件进行统计分析。结果革兰阴性杆菌占67.72%,革兰阳性球菌占14.29%,真菌属占17.99%。引起胆道感染常见的病原菌主要为大肠埃希菌22.75%,铜绿假单胞菌10.58%,肺炎克雷伯菌8.47%,白色念珠菌8.47%,屎肠球菌5.82%等。药敏结果显示:革兰阴性菌对美罗培南耐药率最低(5.53%),其次为亚胺培南和头孢哌酮舒巴坦(均为6.31%),而对氨苄西林,氨苄西林-舒巴坦,头孢呋辛,环丙沙星等高度耐药。革兰阳性菌对万古霉素总耐药率最低(0),其次为替考拉宁和利福平(均为3.71%)及四环素(18.54%),对其他抗生素如美罗培南、亚胺培南、头孢唑林、阿莫西林等均耐药。结论胆道感染中革兰阴性杆菌仍占主要地位,革兰阳性球菌及真菌呈上升趋势,临床常用的抗生素耐药性明显增加,在经验性用药的基础上,要有针对性地合理选用抗生素。Objective To survey the biliary pathogenic bacteria and their sensitivity to antibiotics in biliary tract infection patients,and create guidelines for the selection of antibiotics. Methods The data of 189 strains of pathogen isolated from the positive bile germicuhure during August 2009 to August 2011 were selected,and their sensitivity to antibiotics were statistically analyzed by WHONET 5.3. Results A total of 189 strains were identified,including 128 Gram negative strains（67.72%） ,27 Gram positive strains （14.29%）and 34 fungal strains （17.99%）. The most common pathogenic bacteria were Escherichia coli （22.75%）7 Pseudomonas aeruginosa （ 10.58% ）, Klebsiella pneumoniae （8.47%）, Candida albicans （8.47%）, and Enterococcus faecium （5.82%）. The results of drug susceptibility showed the resistant rates of Gram negative strains against meropenem were the lowest （0） ,followed by those of imipenem and cefoperazone （both 6.31% ）. In this study,Gram negative strains were highly resistant to ampicillin, ampicillin＋sulbactam, cefuroxime and ciprofloxacin. None of Gram positive strains was resistant to vancomycin, and the resistant rates to teicoplanin ,rifampicin and tetracycline were 3.71%, 3.7 1%and 18.54% respectively. Gram negative strains were highly resistant to meropenem,imipenem,cephazolin and amoxicillin. Conclusions Gram negative strains remain most common in biliary tract infection,but the rate of Gram positive strains and fungal are rising. The drug resistance of frequently used antibiotics in clinic increased evidently. Antibiotic agents should be given selectively on the base of empirical medication.

关 键 词：胆道感染 胆汁 细菌培养 抗生素 耐药 

分 类 号：R657.4[医药卫生—外科学]