肝胆系统疾病合并胆道感染患者胆汁培养及耐药性分析  

Bile culture and drug resistance analysis in patients with hepatobiliary disease complicated with biliary tract infection

作　　者：武玉强[1] 陈天宇[1] 胡泽民[1] 梁言珍[1] 颜碧莲[1] 

机构地区：[1]中山大学附属中山医院普通外科一科,广东省中山市528400

出　　处：《中华肝脏外科手术学电子杂志》2017年第1期59-63,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省中山市医学科研基金(2015A020238)

摘　　要：目的分析肝胆系统疾病合并胆道感染患者胆汁培养及药物敏感性(药敏)试验结果,为临床使用抗菌药物提供依据。方法本前瞻性研究对象为2015年1月至2016年8月中山大学附属中山医院136例肝胆系统疾病合并胆道感染患者。其中男83例,女53例,平均年龄(43±10)岁。患者均签署知情同意书,符合医学伦理学规定。收集所有患者的胆汁进行细菌、真菌培养,并行耐药性分析。结果共分离、培养出136株病原菌,其中革兰阴性菌占69.8%,革兰阳性菌占28.7%,真菌占1.5%。其中前5位分别是大肠埃希菌(35.3%)、肺炎克雷伯菌(14.0%)、粪肠球菌(12.5%)、屎肠球菌(9.6%)及铜绿假单胞菌(8.0%)。革兰阴性菌对碳青霉烯类药物耐药率较低;革兰阳性菌对万古霉素、利奈唑胺、替加环素表现出高敏感性,而对红霉素、克林霉素敏感性较低;白假丝酵母菌对伊曲康唑、氟康唑表现出较高的敏感性。结论胆道感染中革兰阴性菌仍占主要地位,然而革兰阳性菌比例明显升高,临床治疗应依据药敏试验结果合理选用抗菌药物,以降低病原菌的耐药性,提高治愈率。Objective To analyze the results of the bile culture and drug sensitivity test in patients with hepatobiliary disease complicated with biliary tract infection to provide reference for clinical use of antibiotics. Methods One hundred and thirty-six patients who were diagnosed with hepatobiliary disease complicated with biliary tract infection in Zhongshan Hospital of Sun Yat-sen University from January 2015 to August 2016 were enrolled in this prospective study. There were 83 males and 53 females with a mean age of （43±10） years old. The informed consents of all patients were obtained and the local ethical committee approval was received. The bile specimens from all patients were collected for bacterial and fungal culture and drug resistance analysis was performed. Results A total of 136 pathogens were isolated and cultured, including 69.8% of gram-negative pathogens, 28.7% of gram-positive pathogens and 1.5% of fungi. The most prevalent fve pathogens were Escherichia coli （35.3%）, Klebsiella pneumonia （14.0%）, Enterococcus faecalis （12.5%）, Enteroccocus faecium （9.6%） and Pseudomonas aeruginosaranked （8.0%）. Low resistance to carbapenems was observed in gram-negative pathogens. Gram-positive pathogens revealed highly sensitive to vancomycin, linezolid and tigecycline, whereas less sensitive to erythrocin and clindamycin. Candida albicans revealed highly sensitive to itraconazole and fuconazole. Conclusions Gram-negative pathogens are the dominant pathogens in biliary tract infection, but the proportion of gram-positive pathogens signifcantly increases. The antibiotic drugs should be selected reasonably according to the results of drug sensitivity test in the clinical teatment to reduce the drug resistance of pathogens and raise the cure rate.

关 键 词：胆道疾病 感染 微生物敏感性试验 

分 类 号：R446.5[医药卫生—诊断学] R657.4[医药卫生—临床医学]