胆汁培养病原体特点及感染类型分析  

Analysis of characteristics of bile cultures and types of bililary infections

作　　者：郁新燕 陈文森 张翔 张永祥 李松琴 张卫红 赵茹[1] 刘波 YU Xinyan1,2, CHEN Wensen2, ZHANG Xiang2, ZHANG Yongxiang2, LI Songqin2, ZHANG Weihong2 ZHAO Ru1, LIU Bo2(1. Department of Infection Control, Jiangyin Hospital Affiliated to Medical School of Southeast University, liangyin, Jiangsu 214400, P. R. China 2. Office of Infection Management, the First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu 210029, P. R. Chin)

机构地区：[1]东南大学医学院附属江阴医院医院感染管理科,江苏江阴214400 [2]南京医科大学第一附属医院感染管理办公室,南京210029

出　　处：《华西医学》2018年第3期284-288,共5页West China Medical Journal

基　　金：江苏高校优势学科建设工程资助项目(JX10231802);江苏省医院协会医院管理创新研究课题(JSYGY-3-2017-198)

摘　　要：目的了解胆汁培养阳性患者病原体分布及抗菌药物使用特点,为合理使用抗菌药物提供依据。方法对某三级医院2016年12月1日—2017年11月30日住院期间胆汁培养阳性患者资料进行回顾性研究,分析胆道感染和定植患者病原体分布、抗菌药物使用情况,胆道感染患者多重耐药菌感染等情况。结果研究期间共送检299份胆汁标本,培养阳性158份,阳性率52.8%。筛选的79例胆汁培养阳性患者共检出110株病原体,其中革兰阴性(G–)菌66株(60.0%)、革兰阳性(G+)菌37株(33.6%)、真菌7株(6.4%)。G–菌检出量前3位分别是大肠埃希菌25株(22.7%)、肺炎克雷伯菌9株(8.2%)、鲍曼不动杆菌7株(6.4%),G+菌检出量前3位分别是屎肠球菌10株(9.1%)、粪肠球菌6株(5.5%)、凝固酶阴性葡萄球菌6株(5.5%)。胆道感染患者42例,胆道定植患者37例,病原体均以G–菌为主。胆道感染患者共检出10株多重耐药菌,多重耐药菌组比非多重耐药菌组抗菌药物使用天数明显延长(t=2.129,P=0.039)。胆道感染患者抗菌药物目标性治疗比例为76.2%;胆道定植患者胆汁培养阳性前抗菌药物合理使用率为16.2%,胆汁培养阳性后抗菌药物合理使用率为78.4%。结论胆汁培养病原体无论感染还是定植均以G–菌为主。疑似胆道感染患者,送检胆汁培养同时应积极送检血培养。胆汁培养阳性应区分感染和定植,并根据药物敏感性结果合理选用抗菌药物。Objective To explore the pathogen distribution and the characteristics of antibiotics use of patients with positive bile culture in order to provide evidence for appropriate antibiotic use. Methods Using a patient-based approach, the clinical and laboratory data of patients with positive bile culture between December 1st 2016 and November 30th 2017 were retrospectively analyzed. The pathogen distribution and antibiotics use of patients with bililary duct infections and colonizations were analyzed. Multidrug-resistant organism infections of patients with bililary duct infections were studied. Results There were 299 submitted bililary samples and in which 158 were culture-positive （52.8%）. One hundred and ten strains of pathogens were found in 79 patients with positive bile culture, including 66 strains of Gram-negative （G–） organisms （60.0%）, 37 strains of Gram-positive （G＋） organisms （33.6%）, and 7 strains of fungi （6.4%）. The top three G– organisms were Escherichia coli （25 strains, 22.7%）, Klebsiella pneumoniae （9 strains, 8.2%）, and Acinetobacter baumanii （7 strains, 6.4%）. The top three G＋ organisms were Enterococcus faecium （10 strains, 9.1%）, Enterococcus faecalis （6 strains, 5.5%）, and coagulase negativeStaphylococcus （6 strains, 5.5%）. The number of patients with bililary duct infections and colonizations were 42 and 37, respectively, with pathogens occupied mainly by G– bacteria. Ten strains of multidrug-resistant organisms were isolated from patients with bililary duct infections. Compared to patients with non-multidrug-resistant organism infections, the length of antibiotics use was longer in patients with multidrug- resistant organism infections （t=2.129, P=0.039）. The rate of target therapy for antibiotics in patients with bililary duct infections was 76.2%. The rate of proper antibiotics use was 16.2% before positive bile culture and 78.4% after positive bile culture in patients with bililary duct colonizations. Conclusions Pathogens isol

关 键 词：胆汁培养 胆道感染 胆道定植 血培养 抗菌药物使用 

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