恶性梗阻性黄疸合并感染的胆汁细菌培养及耐药性分析  

Pathogenic bacteria cultivating by bile of patients with malignant obstructive jaundice complicated with infection and drug resistance analysis

作　　者：王美 WANG Mei(Department of Pharmacy,Luzhong Mine Hospital,Laiwu,Shandong,271113)

机构地区：[1]山东莱芜鲁中矿业有限公司医院药剂科,山东莱芜271113

出　　处：《临床普外科电子杂志》2018年第2期51-55,共5页Journal of General Surgery for Clinicians(Electronic Version)

摘　　要：目的分析恶性梗阻性黄疸合并感染的胆汁中病原菌的构成特点及对抗菌药物的耐药性,为临床治疗提供参考。方法回顾性分析莱芜鲁中矿业有限公司医院2013年11月至2017年11月收治的恶性梗阻性黄疸并感染的患者82例,按照使用抗生素原则的不同分为:A组49例,进行胆汁细菌培养及药敏试验结果,并根据药敏试验选择抗菌药物治疗;B组33例,为对照组,经验性选择抗菌药物治疗,对两组有效率进行分析。结果 49份胆汁中有45份细菌培养阳性(45/49,91.84%),共培养出细菌11种55株,其中,革兰阴性菌39株(70.91%, 39/55),革兰阳性菌15株(27.27%, 15/55),真菌1株(1.82%, 1/55)。革兰阴性菌对哌拉西林/他唑巴坦、亚胺培南、头孢哌酮舒巴坦钠、阿米卡星耐药率低,对阿莫西林、哌拉西林、头孢呋辛、环丙沙星耐药率高,革兰阳性菌对万古霉素、链霉素、阿米卡星、环丙沙星耐药低。A组患者抗生素治疗有效率95.92%(47/49),B组有效率72.73%(24/33),两组比较差异有统计学意义(χ2=4.92, P<0.05)。结论恶性梗阻性黄疸并感染者胆汁致病菌多为革兰阴性菌,药敏试验以β-内酰胺酶抑制剂复合制剂、碳青霉烯类抗菌药物最为敏感,应该根据药敏试验准确选择抗菌药物。Objective To analyze the characteristics of pathogenic bacteria in the bile of malignant obstructive jaundice complicated with cholangeitis and its resistance to antimicrobial agents in order to help clinical treatment.Methods A total of 82 patients with malignant obstructive jaundice complicated with cholangeitis admitted in our hospital.Retrospective analyzed bacterial culture and drug sensitive test results of bile of 49 cases(A group),who treated according to the drug sensitivity test.B group of 33 cases was the control group,who were treated by empiric antibiotic therapy.The difference of efficiency rate between the two groups was analyzed.Results Pathogenic bacteria were detected in 45 patients(91.84%,45/49).A total of 55 strains were detected,which consisted of 39 strains of Gramnegative bacteria(70.91%,39/55),15 strains of Gram-positive bacteria(27.27%,15/55),and 1 strain of fungus(1.82%,1/55).The drug resistance rates of Gram-negative strains to Piperacillin/tazobactam and imipenem were the lowest,followed by cefoperazone sulbactam sodium and amikacin,to Amoxicillin,piperacillin,cefuroxime and ciprofloxacin were higher.For gram positive strains,the drug resistance rates to Vancomycin,streptomycin,amikacin and ciprofloxacin were lower than the else.There was a significant difference in the effective rate of antibiotic therapy between these two groups(A group 95.92%,47/49,B group 72.73%,24/33.χ2=4.92,P<0.05).Conclusions The most common pathogenic bacteria in patients with malignant obstructive jaundice complicated with cholangeitis are Gram-negative bacteria.The sensitivity test is most sensitive to theβ-lactamase inhibitor compound and carbapenem antibiotics,and the antibiotics should be selected exactly according to the drug sensitivity test.

关 键 词：恶性梗阻性黄疸 细菌分析 抗生素 耐药性 

分 类 号：R735.8[医药卫生—肿瘤]