胆道手术者胆汁细菌学和抗生素耐药性研究  

Study on characteristics of bile bacteriology and anti-microbial resistance in patients accepting biliary operations

作　　者：孟珂[1] 孙兰菊[2] 崔云峰[1,3] 刘运德[1] 吴尚为[1,2] 

机构地区：[1]天津医科大学检验学院,天津300203 [2]天津市南开医院检验科,天津300100 [3]天津市南开医院肝胆胰外科,天津300100

出　　处：《中国卫生检验杂志》2017年第11期1661-1664,共4页Chinese Journal of Health Laboratory Technology

摘　　要：目的研究胆道手术者的胆汁细菌学和抗生素耐药特征,了解其在临床科室的分布情况,为院内感染监控和抗生素合理应用提供依据。方法使用Bac T/ALERT 3D血培养仪和VITEK 2 Compact微生物分析仪进行胆汁培养、菌株鉴定和耐药性检测。结果送检胆汁共1 606份,阳性标本980份(61.02%),分离出1 656株病原菌,革兰阴性菌占60.87%,革兰阳性菌占37.98%;阳性胆汁主要源于肝胆胰外科,排名前4位的为大肠埃希菌、肺炎克雷伯菌、粪肠球菌和屎肠球菌。抗生素耐药性分析显示,大肠埃希菌对常用青霉素类、β-内酰胺类和喹诺酮类药物耐药率较高;屎肠球菌对青霉素类、喹诺酮类药物的耐药率较高。大肠埃希菌和肺炎克雷伯菌中,ESBLs菌株的比例为43.21%、18.66%。结论胆汁细菌培养阳性率较高,病原菌种类多,以革兰阴性菌为主,且抗生素耐药率较高。Objective To reveal the characteristics of bacteriology and anti - microbial resistance in the bile from patients ac- cepting biliary operations and to analyze the difference among the major departments in the hospital, in order to provide valuable reference for nosocomial infection control and appropriate antibiotic application. Methods Bacterial culture was performed on BacT/ALERT 3D and the pathogenic isolate identification and anti - microbial resistance assay were carried out using VITEK 2 Compact. Results Of the 1 606 bile samples, 980 samples（61.02% ） were positive, 1 656 bacterial strains were isolated in total, among which the gram - positive and gram - negative bacteria were 60.87% and 37.98%, respectively. The positive strains were originated from the department of hepato - pancreato - biliary surgery. The bacteriological characteristics in different departments were similar, the top four bacteria were Escherichia coli, KlebsieUa pneumoniae, Enterococcus faecalis and Entero- coccus faecium. Anti - microbial resistance analysis showed that Escherichia coli had high resistance rates towards common penicillins, 13 -lactams and quinolones, the anti -microbial resistance rates of Enterococcus faecium to penicillins and quinolones were higher. In addition, the portions of ESBLs were 43.21% and 18.66% in Escherichia coli and Klebsiella pneumonia. Conclusion The bacterial cultures of bile samples showed high positive rate and a variety of pathogenic microorganisms were isolated, the gram - negative bacteria were the predominant strains and high antibiotic resistance rates were detected in most of species.

关 键 词：胆汁 细菌 耐药性 超广谱Β-内酰胺酶 

分 类 号：R378[医药卫生—病原生物学]