胆结石合并胆道感染病原菌谱及耐药机制分析  

Analysis of the spectrum of pathogenic bacteria causing biliary tract infections in patients with gallstones and their drug resistance mechanisms

作　　者：徐红云[1] 陈弟[1] 袁文丽[1] 张唤 刘春林[1] 吕红玲[1] 龙湖波 马众仙[1] 赵珠[1] Xu Hong-yun;Chen Di;Yuan Wen-li;Zhang Huan;Liu Chun-lin;Lti Hong-ling;Long Hu-bo;Ma Zhong-xian;Zhao Zhu(Department of Laboratory Medicine,the Second People＇s Hospital of Yunnan Province,Kunming 650021)

机构地区：[1]云南省第二人民医院检验科,昆明650021

出　　处：《中国抗生素杂志》2018年第10期1252-1256,共5页Chinese Journal of Antibiotics

摘　　要：目的了解某三甲医院胆结石合并胆道感染的病原菌菌谱,常见细菌的耐药性及多重耐药菌的耐药机制。方法收集2013—2016年某医院收治的胆结石合并胆道感染的住院患者资料,对其胆汁或胆囊组织的细菌培养及细菌的体外药物敏感试验的结果进行回顾性分析,采用聚合酶链反应(PCR)分别检测产超广谱β-内酰胺酶(ESBLs)菌株及CRE菌株耐药基因型。结果胆道感染的细菌是革兰阴性菌73.6%(276/375)、革兰阳性菌25.1%(94/375)及念珠菌1.3%(5/375),其中混合感染病例13.3%(52/391),感染前3位的细菌是大肠埃希菌(36.00%, 135/375)、肺炎克雷伯菌(14.93%, 56/375)及屎肠球菌(6.67%, 25/375);产ESBLs检出率52.36%(111/212),耐碳青霉烯类的肺炎克雷伯菌(CRKP)8.93%(5/56);产ESBLs菌株主要携带的耐药基因为blaCTX-M 100%, blaCTX-M+TEM 41.44%,blaCTX-M+SHV 30.63%;CRKP株的耐药基因均为blaKPC-2型;产ESBLs菌株的耐药率显著高于非ESBLs菌株(P<0.01);屎肠球菌对常用抗菌药物的耐药率明显高于粪肠球菌(P<0.01),粪肠球菌对万古霉素及利奈唑胺的敏感率为100%,而有4.2%的屎肠球菌对万古霉素耐药。结论胆道感染的病原菌主要以肠道菌群的大肠埃希菌、肺炎克雷伯菌和粪肠球菌为主,不同病原菌的耐药性差异较大,产ESBLs菌株携带多种耐药基因;了解胆道感染病原菌分布及多重耐药菌的耐药机制,为临床合理选择抗菌药物提供依据。Objective To study the spectrum of pathogenic bacteria causing biliary tract infections in patients with gallstones, common bacterial resistance, and drug resistance mechanisms of multiple drug-resistant bacteria. Methods The data of inpatients with biliary tract infections collected in a hospital from 2013 to 2016 were retrospectively analyzed on the results of bacterial culture of bile or gallbladder tissues and in vitro drug susceptibility test of bacteria. Polymerase chain reaction （PCR） were used to detect the genotypes of resistant extended-spectrum β-lactamase （ESBLs） and CRE strains. Results The pathogenic bacteria causing biliary tract infections are Gram-negative bacteria 73.6% （276/375）, Gram-positive bacteria 25.1% （94/375）, and fungi 1.3% （5/375）, with a mixed infection of 13,3% （52/391）. The dominant bacteria were Escherichia coli （36.00%, 135/375）, Klebsiella pneumoniae （14.93%, 56/375）, and Enterococcus faecium （6.67%, 25/375）. The detection rate of ESBLs was 52.36%, and that of carbapenem-resistant Klebsiella pneumoniae （CRKP） was 8.93%, The major drug-resistant genes of ESBLs-producing strains were blaCTX-M 100%, blaCTX-M＋TEM 44.14%, and blaCTX-M＋SHV 30.63%, The resistance gene of CRKP strain is the blKPC-2 type. The drug resistance rates of Escherichia coli and Klebsiella pneumoniae producing ESBLs and non-ESBLs strains were significantly different （P〈0.01）. The resistance rate of Enterococcusfaecium to commonly used antimicrobials was significantly higher than that of Enterococcusfaecalis （P〈0.01）. The sensitivity of Enterococcus faecalis to vancomycin and linezolid was 100%, and the detection rate of the vancomycin resistance was 4.2%. Conclusions The main pathogens causing biliary infections in patients with gallstones are intestinal flora Escherichia coli, Klebsiella pneumoniae and Enterococcus faecalis. Different pathogenic bacteria have differences in drug resistance. The ESBLs-producing strains carry a variety of drug resistance ge

关 键 词：胆道感染 病原菌谱 耐药率 耐药机制 

分 类 号：R978.1[医药卫生—药品]