胆石症合并急性胆管炎患者胆汁及血液病原菌培养及药敏分析  

Bile and blood bacterial flora and its antibiotic sensitivity in patients with acute cholangitis combined with choledocholithiasis

作　　者：邹雪飞[1] 吴广利[1] 王伟[1] 刘成霞[1] 牛琼[1] 马锋振[1] 

机构地区：[1]滨州医学院附属医院消化内科,滨州市256603

出　　处：《中华实验和临床感染病杂志（电子版）》2015年第1期89-93,共5页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的观察胆石症合并急性胆管炎患者胆汁及血液中病原菌的分布特征、培养阳性率及其对抗菌药物的敏感性,指导临床合理选择和应用抗菌药物。方法选取2011年1月至2014年1月本院消化内科诊断为急性胆道感染、经内镜逆行性胰胆管造影术(ERCP)术中证实存在结石的97例患者的胆汁标本,所有胆汁标本均进行普通细菌、厌氧菌及真菌培养,其中33例行血培养,分别对其病原菌培养及药敏结果进行分析,同时对97例患者术前经验性应用的抗菌药物情况进行统计分析。结果 97例胆汁培养者中73例检出病原菌,阳性率为75.3%。胆汁标本中共分离出病原菌77株,其中革兰阴性菌60珠,革兰阳性菌14株,真菌3株,革兰阴性菌中排名居前3位的细菌分别是大肠埃希菌(43株,55.8%)、克雷伯菌属(6株,7.8%)、阴沟肠杆菌(4株,5.2%)。33例血培养者17例检出病原菌,阳性率为51.5%。血培养中分离出病原菌17株,大肠埃希菌15株,肺炎克雷伯菌1株,梭杆菌属1株。革兰阴性菌对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦和阿米卡星敏感性较高(敏感率分别为93.3%、88.3%和83.3%),未发现对亚胺培南及美罗培南耐药者。对氨曲南和左氧氟沙星敏感性最低(敏感率均为23.0%)。97例患者术前均经验性应用抗菌药物,55例应用单一抗菌药物抗感染,主要为左氧氟沙星(34/55),其次为头孢哌酮/舒巴坦(11/55)和其他(10/55);42例两联抗感染治疗,主要为左氧氟沙星+甲硝唑(16/42)、头孢哌酮/舒巴坦+甲硝唑(15/42)和其他(11/42)。结论胆石症合并急性胆道感染者胆汁中及血液中的主要病原菌为革兰阴性菌,且均以大肠埃希菌为主。头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、阿米卡星敏感性较高,可作为首选抗菌药物,亚胺培南、美罗培南作为备选抗菌药物,在严重感染或其他抗菌药物无效的情况下考虑使用。左氧氟沙星、氨曲南在胆道结石并胆道Objective To investigate the characteristics of microbial isolates and the positive rate from bile and blood cultures taken from patients with cholangitis resulting from choledocholithiasis, and to compare antimicrobial sensitivities and to guide the rational choice and use of antibiotics. Methods Bile cultures and antibiograms from 97 patients hospitalized between January 2011 to January 2014 in our hospital were reviewed. Specimens were obtained from patients with cholangitis and confirmed choledocholithiasis during endoscopic retrograde cholangiopancreatography （ERCP）, the bile specimens were examined for pathogenic aerobic and anaerobic bacteria and fungi, there were 33 blood samples among them were cultured simultaneously. Data on microbial isolates and antimicrobial sensitivities were analyzed, respectively. At the same time, the empirical antibiotics of the 97 cases prior to operation were also analyzed. Results Bile culture was positive in 73 among 97 cases, the positive culture rate was 75.3%, a total of 77 pathogens were isolated in bile culture： 60 Gram-negative bacteria, 14 Gram-positive bacteria and 3 fungus. The most common Gram-negative pathogens were Escherichia coli （55.8%）, Klebsiella （7.8%）, Enterobactercloacae （5.2%）. Blood culture was positive in 17 among 33 cases, the positive culture rate was 51.5%, 17 pathogens were isolated in blood culture, including Escherichia coli （15 strains）, Klebsiella （1 strain）, Fusobacterium （1 strain）. The more sensitive antibiotics against Gram-negative bacteria were cefoperazone/ sulbactam, piperacillin/tazobactam, amikacin （susceptibility 93.3%, 88.3% and 83.3%, respectively）. The lower susceptibility rate of Gram-negative to fourteen kings of antimicrobial agents was levofloxacin and aztreonam （with susceptibility rate for 23.0%）. There were no resistance for imipenem and meropenem. Empirical antibiotic therapy was prescribed prior to operation in all cases, monotherapy was used in 55 cases, the main drug was levofloxac

关 键 词：胆石症 胆道感染 胆汁培养 药物敏感性试验 

分 类 号：R446.5[医药卫生—诊断学]