梗阻性黄疸患者胆汁病原菌培养及药敏分析  

Bacterial culture of bile from patients with obstructive jaundice and antibiotic sensitivity

作　　者：李静[1] 吴广利[1] 牛琼[1] 肖欣[1] 刘会娜[1] 蔡译苇 

机构地区：[1]滨州医学院附属医院消化内科,山东滨州256603

出　　处：《中国内镜杂志》2018年第2期94-99,共6页China Journal of Endoscopy

摘　　要：目的观察梗阻性黄疸患者胆汁病原菌的分布特征、培养阳性率及其对抗菌药物的敏感性,指导临床合理应用抗菌药物。方法选取2012年1月-2016年4月该院消化内科及肝胆外科诊断为梗阻性黄疸的322例患者的胆汁标本,所有胆汁标本均行普通细菌、厌氧菌及真菌培养,分析药敏试验结果,并对322例患者术前经验性应用抗菌药物进行统计。结果 322例胆汁标本中246例检出病原菌,阳性率为76.40%。共分离出病原菌267株:革兰阴性菌208珠,革兰阳性菌48株,真菌11株。排名前3位的病原菌为大肠埃希菌(142株,53.18%)、屎肠球菌(28株,10.49%)、肺炎克雷伯菌(27株,10.11%)。革兰阴性菌对亚胺培南及美罗培南敏感性最高(敏感率均为98.08%),其次为头孢哌酮/舒巴坦、阿米卡星、哌拉西林/他唑巴坦(敏感率分别为92.31%、88.46%和85.58%),对左氧氟沙星和氨曲南敏感性最低(敏感率分别为29.81%、28.37%)。革兰阳性菌对利奈唑胺、替考拉宁、万古霉素敏感性最高(敏感率均为100.00%),其次为氯霉素(敏感率88.89%),对左氧氟沙星敏感性较低(敏感率25.00%)。281例患者术前经验性应用抗菌药物,219例单一抗感染治疗,主要为左氧氟沙星(86/219),其次为头孢哌酮/舒巴坦(70/219);62例两联抗感染治疗,主要为头孢哌酮/舒巴坦+奥/甲硝唑(27/62),其次为左氧氟沙星+奥/甲硝唑(12/62)。结论梗阻性黄疸患者胆道感染病原菌主要为革兰阴性菌,且以大肠埃希菌为主,头孢哌酮/舒巴坦、阿米卡星、哌拉西林/他唑巴坦敏感性较高,可作为首选抗菌药物,亚胺培南、美罗培南作为备选抗菌药物,在严重感染或其他抗菌药物无效的情况下考虑使用;术前经验性应用抗菌药物针对性不强,左氧氟沙星在梗阻性黄疸中耐药率高,临床经验性应用抗菌药物时应避免选用。Objective To investigate the characteristics of microbial isolates and the positive rate from bile cultures taken from obstructive jaundice patients, then compare the antimicrobial sensitivities to guide the rational choice and use of antibiotics. Methods Bile cultures from 322 patients from January 2012 to April 2016 were reviewed. Specimens were obtained from patients that were diagnosed obstructive jaundice. The bile specimens were examined for pathogenic respectively. At the same time, the empirical antibiotics of the 322 cases prior to operation were also analyzed. Results Bile culture was positive in 246 among322 cases, the positive culture rate was 76.40%. A total of 267 pathogens were isolated in bile culture： 208 Gram-negative bacteria, 48 Gram-positive bacteria and 11 fungus. The most common pathogens in all were Escherichia coli （208 strains, 53.18%）, Enterococcus faecium （28 strains, 10.49%）, Klebsiella pneumoniae （27 strains, 10.11%）. The most sensitive antibiotics against Gram-negative bacteria were imipenem and meropenem （with susceptibility rate for 98.08%, respectively）. The more sensitive antibiotics against Gram-negative bacteria were efoperazone/sulbactam, amikacin, piperacillin/tazobactam （susceptibility 92.31%, 88.46% and 85.58%）. The lowest susceptibility rate of Gram-negative to twelve kings of antimicrobial agents were levofoxacin, andaztreonam （susceptibility 29.81%, 28.37%）. The most sensitive antibiotics against Gram-positive bacteria were linezolid, teicoplanin and vancomycin（with susceptibility rate for 100.00%, respectively）. The more sensitive antibiotics against Gram-positive bacteria was chloromycrtin （susceptibility 88.89%）. The lower susceptibility rate of Gram-positive were levofloxacin （susceptibility 25.00%）. 281 cases of patients before surgery empirical use of antimicrobial drugs. Monotherapy was used in 219 cases. The main drug was levofoxacin （86/219）, the second was cefoperazone/sulbactam （70/219）. The dual therapy was

关 键 词：梗阻性黄疸 胆汁培养 药物敏感性试验 经验性用药 

分 类 号：R575[医药卫生—消化系统] R446.5[医药卫生—内科学]