外科胆道感染病原菌单中心30年变迁  

Change of pathogens in patients with biliary tract infection treated in a single center during the past 30 years

作　　者：吕骅[1] 朱明炜[1] 牛小娟[1] 崔红元[1] 乔江春[1] 胡云建[1] 

机构地区：[1]北京医院普通外科,100730

出　　处：《中华肝胆外科杂志》2016年第9期611-613,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的调查单个中心外科胆道感染病原菌30年的变迁和药物敏感性变化。方法选择北京医院1981—1984、1988—1998和2003—2013三个时间段各100例接受胆总管探查手术患者。术中穿刺胆总管获得胆汁标本，进行细菌培养和药物敏感性实验检查，分析胆道病原菌的变化过程以及药物敏感性的变化。结果1981—1984年胆汁培养结果以大肠埃希菌（59．2％）和克雷伯菌（28．9％）为主，两者的混合感染比例为16．9％；1988—1998年细菌种类显著增加，大肠埃希菌（33．1％）和克雷伯菌（16．5％）虽排在前，但总比例降至50％以下，混合感染（21．0％）以大肠埃希菌合并铜绿假单胞菌最为常见。2003—2013年细菌种类以革兰氏阴性菌为主（61．8％），大肠埃希菌（20．1％）和铜绿假单胞菌（10．4％）居前，总比例下降；革兰阳性菌所占比例显著增加，其中屎肠球菌（22．2％）成为比例最高的细菌。混合感染显著增加（36％），超过半数是大肠埃希菌合并屎肠球菌；真菌比例（5．6％）较80和90年代显著增加。结论近年来胆道感染病原菌种类发生显著变化，革兰阳性菌和真菌显著增加。临床应根据细菌药敏实验结果选择合适的抗菌药物，减少细菌耐药性。Objective To investigate the changes of pathogens and antimicrobial susceptibility in pa- tients with biliary tract infection during the past 30 years. Methods During the periods of 1981-1984, 1988- 1998 and 2003-2013, each 100 patients treated with common bile duct exp/oratoration were selected from every period. Biopsied bile specimens were performed with bacteria culture and antimicrobial susceptibility tests. This study reviewed the changes in bilary pathogens and antimierobial susceptibility test. Results From 1981 to 1984, the most common pathogens were Escherichia coli （59.2%） and Klebsiella pneumonia （28.9%）. Mixed infection of these pathogens accounted for 16.9%. From 1988 to 1998, the types of pathogens signifi- cantly increased. Escherichia coli （33.1%） and Klebsiellapneumonia （16. 5% ） accounted for less than 50%. Mixed infection with Escherichia coli and Pseudomonas aeruginosa was the most common type. From 2003 to 2013, gram-negative bacteria were still the main pathogens, accounting for 61.8%. Escherichia coli and Pseudomonas aeruginosa accounted for 20.1% and 10.4% , respectively. Gram-positive bacteria increased sig- nificantly. Enterococcus fnecium （22.2%） ranked the first. Mixed infection increased （ 36% ）, of which more than 50% was mixed pathogens of Escherichia coli and Enterococcus faecium. The incidence of fungi infection also increased （5.6%）. Conclusions There was a remarkable change of pathogen category in the biliary infections over the past years. With an increase of gram-positive bacteria and fungi infection in clinical practice, antimicrobial susceptability results could be considered in choosing appropriate drug to avoid bacterial resistance.

关 键 词：胆道感染 病原菌 药敏试验 耐药率 

分 类 号：R446.5[医药卫生—诊断学] R575.6[医药卫生—临床医学]