临床胆汁分离细菌培养与药物敏感试验结果分析  

Distribution and drug resistance analysis of bile-isolated pathogens In Xiamen area

作　　者：房丽丽[1] 李珣[1] 马晓波[1] 林贵兰[1] 郑燕青[1] 陈世东[1] 郑港森[1] 

机构地区：[1]厦门大学附属第一医院暨福建医科大学教学医院检验科,福建厦门361003

出　　处：《国际检验医学杂志》2016年第4期449-451,共3页International Journal of Laboratory Medicine

基　　金：国家自然科学基金资助项目(81302529);福建省自然科学基金资助项目(2014D007)

摘　　要：目的分析胆道感染病原菌分布和药敏试验结果,为临床合理用药提供依据。方法 2013年4月至2014年9月厦门大学附属第一医院胆汁标本采用法国生物梅里埃公司BacT/ALERT 3D全自动血培养仪及配套的血培瓶进行增菌培养,全自动微生物鉴定药敏分析仪进行细菌鉴定及药敏试验,运用WHONET 5.6软件进行数据统计分析。结果 217例胆道感染患者有35例(16.1%)分离出2种病原菌,其中肠球菌属与肠杆菌科细菌混合感染(19例,54.3%)最常见;共分离出252株非重复菌株,革兰阳性菌83株(32.9%),革兰阴性菌165株(65.5%),真菌4株(1.6%);分离率居前3位为大肠埃希菌、粪肠球菌和肺炎克雷伯菌;最常见的非发酵菌为铜绿假单胞菌和鲍曼不动杆菌。常见肠杆菌科细菌对氨基糖苷类、4代头孢类、碳青霉烯类和哌拉西林/他唑巴坦耐药率低于40.0%,大肠埃希菌对喹诺酮类的耐药率大于50.0%;粪肠球菌和屎肠球菌对万古霉素、利奈唑胺和替加环素的耐药率极低,对高浓度链霉素和高浓度庆大霉素的耐药率均小于30.0%。结论该地区胆道感染常见病原菌为大肠埃希菌、粪肠球菌和肺炎克雷伯菌,肠球菌属和肠杆菌科细菌混合占2种病原菌混合感染很大比例,病原菌对头孢类和喹诺酮类抗菌药物的耐药性日趋严峻。Objective To analyze the distribution and drug resistance of bile-isolated pathogens in Xiamen area,providing evidence for clinical use of antibiotics.Methods Bile cultures and antibiotic susceptibility tests were performed on strains isolated from the First Affiliated Hospital of Xiamen University.WHONET 5.6was used for data analysis.Results In 35 out of 217 samples,2kinds of pathogens were isolated.Among these,Enterococcus and Enterobacteriaceae coinfection was most common.There were 252 strains isolated totally,with 83gram-positive strains（32.9%）,165gram-negative strains（65.5%）and 4fungi strains（1.6%）.Escherichia coli,Enterococcus faecalis and Klebsiella pneumoniae were three of the most common pathogens isolated.Pseudomonas aeruginosa and Acinetobacter baumannii were two of the most common nonfermenters isolated.The resistance rates of Enterobacteriaceae to aminoglycosides,fourth generation cephalosporins,carbapenems or piperacillin/tazobactam were lower than 40.0%.The resistance rate of Escherichia coli to quinolones was higher than 50.0%.Enterococcus faecalis or enterococcus faecium were less resistant to vancomycin,linezolid and tigecycline.The resistance rates of enterococcus to high concentration of streptomycin or gentamicin were lower than 30.0%.Conclusion The top three common pathogens isolated from bile are Escherichia coli,Enterococcus faecalis and Klebsiella pneumonia in Xiamen area.Infections by Enterococcus together with Enterobacteriaceae account for large numbers of coinfection cases.The resistance rates to cephalosporin or quinolones of pathogens causing biliary tract infections have increased dramatically.

关 键 词：胆道感染 病原菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学]