老年急性胆囊炎240例病原学分析  

Analysis of etiology in 240 elderly patients with acute cholecystitis

作　　者：赵丽[1] 严琦敏[2] 王向平[3] 郭学刚[3] 许昌泰[4] 

机构地区：[1]第四军医大学唐都医院消化科,陕西西安710038 [2]解放军第323医院肝胆外科,陕西西安720054 [3]第四军医大学西京医院消化科,陕西西安710032 [4]第四军医大学<神经解剖学杂志>编辑部,陕西西安710032

出　　处：《新乡医学院学报》2016年第8期664-667,共4页Journal of Xinxiang Medical University

基　　金：国家自然科学基金面上项目(编号:30872965;30971337)

摘　　要：目的研究老年急性胆囊炎患者的病原学及其药物敏感性。方法选择2005年1月至2014年12月确诊并有完整病原学资料的外科手术的老年急性胆囊炎患者240例,均常规收集胆汁并进行细菌培养鉴定和药物敏感性试验。结果 240份标本培养鉴定出病原菌428株,其中革兰阴性菌332株(77.6%),包括大肠埃希菌(144株,33.7%)、肺炎克雷伯菌(104株,24.3%)、铜绿假单胞菌(52株,12.1%)和鲍曼不动杆菌(32株,7.5%);革兰阳性菌82株(19.4%),包括金黄色葡萄球菌(36株,8.4%)、表皮葡萄球菌(24株,5.6%)和肠球菌(22株,5.1%);真菌14株(3.3%)。革兰阴性菌对哌拉西林、他唑巴坦和头孢曲松的耐药率超过80%,对大多数抗菌药物的耐药则超过50%。革兰阳性菌对氨苄西林、红霉素和克林霉素的耐药率超过80%,对其他抗菌药的耐药率超过40%。结论革兰阴性菌是老年急性胆囊炎主要致原菌,且对大多数抗菌药物具有多重耐药性。Objective To observe the etiology of elderly patients with acute cholecystitis and analyze the drug sensitivi- ty of pathogenic bacteria. Methods Two hundred and forty surgical acute cholecystitis patients who were diagnosed from Janu- ary 2005 to December 2014,and had complete record of etiology data were selected. The bile was routinely collected and the bacterial culture, identification and drug sensitivity tests were performed in all patients. Results Of the 240 specimens, 428 strains of pathogenic bacteria were cuhured and identified in which 332 （ 77.6% ） strains gram negative bacteria were identi- fied, including Echerichia coli 144 strains （ 33.7% ）, Klebsiella pneumonia 104 strains （ 24.3% ） , Pseudomonas aeruginosa 52 strains（ 12.1% ） and Bauman acinetobacter 32 strains（ 7.5% ） ;82 （19.4%）strains gram positive bacteria were identified, in- cluding Staphylococcus aureus 36 strains （ 8.4% ）, Staphylococcus aureus 24 strains （ 5.6% ） and Enterococcus 22 strains （5.1%） ;and 14 strains（3.3% ） fungi were identified. Drug sensitivity test results showed that the resistance rate of gram negative bacteria to piperacillin, tazobactam and ceftriaxone was more than 80% and the resistant rate of gram negative bacteria to mostly antimicrobial agents was more than 50%. The resistance rate was more than 80% of gram positive bacteria to ampicil- lin,erythromycin and clindamycin, and the resistance rate was more than 40% to other antimicrobial agents. Conclusion Gram negative bacteria are the main pathogenic bacteria in elderly patients with acute cholecystitis, and it has drug resistance to most antimicrobial agents.

关 键 词：胆石症 急性胆囊炎 药物敏感性试验 耐药性 

分 类 号：R657.4[医药卫生—外科学]