119例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 from 119 cases of biliary tract infections

作　　者：俞幼林[1] 许根兔[1] 朱锦龙[1] 

机构地区：[1]绍兴市第六人民医院肝胆外科,浙江绍兴312000

出　　处：《中国微生态学杂志》2015年第5期593-595,共3页Chinese Journal of Microecology

摘　　要：目的探讨胆道感染患者胆汁培养的病原菌的分布及耐药性,为临床医师有针对性的选择抗菌药物治疗胆道感染提供依据。方法对2010年6月至2012年6月119例胆道感染患者胆汁中分离得到的菌株进行回顾性分析。结果 119例胆道感染患者的胆汁标本中共分离出病原菌80株,阳性检出率为67.2%。其中,检出的革兰阴性杆菌57株,占71.3%;革兰阳性球菌14株,占17.5%,真菌9株,占11.2%。排名病原菌前3位的分别为大肠埃希菌(36.3%)、粪肠球菌(13.8%)、肺炎克雷伯杆菌(12.5%);大肠埃希菌及肺炎克雷伯杆菌对美罗培南的耐药率分别为3.4%和0.0%、哌拉西林/他唑巴坦及阿米卡星的耐药率均是6.9%和10.0%。肺炎克雷伯杆菌对左氧氟沙星的敏感率明显高于大肠埃希菌,分别为64.4%与38.4%。头孢菌素类药物中头孢噻肟的耐药率最高,分别是72.4%和60.0%。粪肠球菌除对糖肽类万古霉素及替考拉宁的敏感率为100.0%外,对其他抗菌药物均有一定的耐药性。在检测出的39株大肠埃希菌和肺炎克雷伯杆菌中分离到产ESBLs细菌17株,阳性检出率为43.6%。结论摒弃经验性用药、避免预防性用药、增加标本送检率、结合药敏结果合理选择抗菌药物以及规范手术操作,才能达到提高治疗胆道感染成功率的目的。Objective To investigate the distribution and drug resistance of pathogenic bacteria from the bile of patients with biliary infection,and provide basis for selection of antimicrobial drugs. Methods The pathogens isolated from the bile specimens of 119 patients with biliary tract infection during June 2010 and June 2012 were analyzed retrospectively. Results 80 strains of pathogens were isolated; the positive rate was 67. 2%. Among them,there were 57 strains of Gram negative bacilli（ 71. 3%）,14 strains of Gram positive cocci（ 17. 5%）,and 9strains of fungi（ 11. 2%）. The top 3 pathogens were Escherichia coli（ 36. 3%）,Enterococcus faecalis（ 13. 8%）and Klebsiella pneumoniae（ 12. 5%）. The resistance rates of Escherichia coli and Klebsiella pneumoniae were3. 4% and 0. 0% to meropenem,and 6. 9% and 10. 0% to Piperacillin / tazobactam or Amikacin,respectively.The resistance of Klebsiella pneumoniae to Levofloxacin（ 64. 4%） was significantly higher than that of Escherichia coli（ 38. 4%）. The highest resistance was to Cefotaxime,72. 4% and 60. 0% respectively. Enterococcus faecalis were 100% sensitive to Vancomycin and Teicoplanin while resistant to other antibacterial drugs. In the 39 strains of Escherichia coli and Klebsiella pneumoniae isolated, 17 strains of ESBLs producing bacteria were detected（ 43. 6%）. Conclusion Empirical treatment and preventive medication should be avoided,more specimens should be detected,antibacterials should be selected based on susceptibility test results,and medical operation should be standardized so as to improve the success rate of treatment of biliary tract infection.

关 键 词：胆汁 胆道感染 病原菌 耐药性 

分 类 号：R373.2[医药卫生—病原生物学]