胆道感染患者胆汁病原菌分布及耐药性分析  

Distribution and drug resistance of pathogens cultured from bile of patients with biliary tract infections

作　　者：王军[1] 余清源 刘华[1] 瞿秀[1] 

机构地区：[1]利川市人民医院检验科,湖北利川445400

出　　处：《中华医院感染学杂志》2014年第14期3431-3432,3435,共3页Chinese Journal of Nosocomiology

基　　金：湖北省卫生厅基金资助项目(WJ01564)

摘　　要：目的调查分析胆道感染患者胆汁培养检出的201株病原菌种类及耐药性,为临床医师选择抗菌药物治疗提供实验室参考依据。方法调查2010年1月-2012年12月就诊的胆道感染患者临床资料,行胆道手术无菌留取胆汁标本进行培养和细菌的鉴定。结果胆道感染患者送检的312份胆汁标本中培养出201株病原菌,阳性检出率为64.4%;革兰阴性杆菌占66.2%、革兰阳性球菌占24.4%、真菌9.4%,检出第1位是大肠埃希菌91株占45.3%,检出第3位是粪肠球菌31株占15.4%;肠杆菌科细菌对碳青霉烯类、粪肠球菌对糖肽类抗菌药物100.0%敏感;革兰阴性杆菌耐药率>40.0%的药物有磺胺甲噁唑/甲氧苄啶、庆大霉素、头孢噻肟、左氧氟沙星、环丙沙星,耐药率<20.0%药物主要有阿米卡星、亚胺培南、美罗培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦,产超广谱β-内酰胺酶(ESBLs)细菌检出率为42.5%。结论胆道感染病原菌多源于肠道菌群,且病原菌的耐药性处于上升状态,医院应加强执行《抗菌药物临床应用管理办法》,提高医师合理用药理念,改变细菌耐药性快速上升的不良态势。OBJECTIVE To investigate the distribution and drug resistance of 201strains of pathogens cultured from bile specimens obtained from the patients with biliary tract infections so as to provide guidance for reasonable clinical use of antibiotics.METHODS The clinical data of the patients with biliary tract infections who were treated from Jan 2010to Dec 2012were investigated,then the bile specimens were cultured,the identification of the pathogens was performed.RESULTS A total of 201strains of pathogens have been cultured from 312submitted bile specimens of the patients with biliary tract infections with the positive isolation rate of 64.4%,among which the gram-negative bacilli accounted for 66.2%,the gram-positive cocci 24.4%,the fungi 9.4%;among the isolated pathogens,the Escherichia coli ranked the first place,accounting for 45.3%（91strains）,and the Enterococcus faecalis ranked the third place,accounting for 15.4%,（31strains）.The drug susceptibility rate of the Enterobacteriaceae to carbapenems was 100.0%;the drug susceptibility rate of the E.faecalis to glycopeptides was100.0%;the drug resistance rates of the gram-negative bacilli to sulfamethoxazole-trimethoprim,gentamicin,cefotaxime,levofloxacin,and ciprofloxacin were more than 40.0%;the drug resistance rates to amikacin,imipenem,meropenem,cefoperazone-sulbactam,and piperacillin-tazobactam were less than 20.0%.The isolation rate of the extended-spectrumβ-lactamases（ESBLs）-producing bacteria was 42.5%.CONCLUSION Most of the pathogens causing biliary tract infections are the intestinal flora,and the drug resistance of the pathogens shows an upward trend.It is necessary for the hospital to strengthen the implementation of measures for clinical use and administration of antibiotics and improve the awareness of reasoanbel medication of the clinician so as to curb the rapid increase of bacterial drug resistance.

关 键 词：胆道感染 胆汁培养 病原菌 构成比 耐药性 

分 类 号：R378[医药卫生—病原生物学]