细菌性肝脓肿与胆道感染的病原菌及药敏试验比较分析  

Comparative study of the pathogen and drug susceptibility test between bacterial liver abscess and biliary tract infection

作　　者：陈圣开 吴晓春 刘永[2] CHEN Shengkai;WU Xiaochun;LIU Yong(Hepatobiliary Surgery,Chongqing General Hospital,Chongqing 400014,China;Chongqing Medical and Pharmaceutical College,Chongqing 401331,China)

机构地区：[1]重庆市人民医院肝胆外科,重庆400014 [2]重庆医药高等专科学校,重庆401331

出　　处：《安徽医药》2020年第5期981-985,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的了解当前细菌性肝脓肿和胆道感染的病原菌及药敏试验结果差异,便于指导临床治疗。方法回顾性收集和分析2012年3月至2018年9月重庆市人民医院收治的64例细菌性肝脓肿和269例胆道感染病人的细菌培养和药敏试验资料及相关临床资料。结果细菌性肝脓肿检出细菌52株(7种),包括肺炎克雷伯菌31株(59.6%)、链球菌8株(15.4%)、铜绿假单胞菌7株(13.5%)、其他6株(11.5%),其中革兰阴性菌占78.8%,革兰阳性菌占21.2%。胆道感染检出细菌123株(13种),包括大肠埃希菌47株(38.2%)、肺炎克雷伯菌30株(24.4%)、阴沟肠杆菌13株(10.6%)、其他33株(26.8%),其中革兰阴性菌占81.3%,革兰阳性菌占18.7%。细菌性肝脓肿的革兰阴性菌耐药率较低的抗生素包括:阿米卡星(0.0%)、厄他培南(0.0%)、亚胺培南(2.2%)、头孢他啶(4.4%)、头孢吡肟(4.4%)、氨曲南(6.7%)、哌拉西林/他唑巴坦(8.9%)、头孢替坦(8.9%)、左氧氟沙星(8.9%)、妥布霉素(11.1%)等,胆道感染革兰阴性菌耐药率较低的抗生素包括:阿米卡星(0.0%)、厄他培南(0.0%)、亚胺培南(4.2%)、哌拉西林/他唑巴坦(5.3%)、妥布霉素(6.3%)等。两种感染多重耐药菌株比例分别为38.5%、30.9%(P>0.05)。结论两种感染的致病菌均以革兰阴性菌为主,但细菌性肝脓肿的致病菌以肺炎克雷伯菌最常见,胆道感染的致病菌以大肠埃希菌最常见。对两种感染的革兰阴性菌均较敏感的抗生素包括阿米卡星、厄他培南、亚胺培南、哌拉西林/他唑巴坦、妥布霉素。不同之处在于:头孢他啶、头孢吡肟、头孢替坦、氨曲南和左氧氟沙星对引起细菌性肝脓肿的革兰阴性菌较敏感,但对引起胆道感染的革兰阴性菌敏感性较差。Objective To investigate the difference of pathogen and drug susceptibility test between bacterial liver abscess and bili ary tract infection at present,so as to guide clinical therapy.Methods The clinical data of the bacterial culture and drug susceptibili ty test etc.of 64 patients with bacterial liver abscess and 269 patients with biliary tract infection admitted to Chongqing General Hospi tal from March 2012 to September 2018 were collected retrospectively and analysed.Results A total of 52 strains(7 types)of bacte ria were isolated from pus or blood of the 64 cases of bacterial liver abscess,including 31 strains of Klebsiella pneumonia(59.6%),8 strains of streptococcus(15.4%),7 strains of Pseudomonas aeruginosa(13.5%),and 6 other strains(11.5%),among which 78.8%(41/52)were Gram negative bacteria and 21.2%(11/52)were Gram positive.A total of 123 strains(13 types)of bacteria were isolated from bile of the 269 cases of biliary tract infection,including 47 strains of Escherichia coli(38.2%),30 strains of Klebsiella pneumo nia(24.4%),13 strains of Enterobacter cloacae(16.6%)and 33 other strains(26.8%),among which 81.3%(100/123)of the bacteria were Gram negative,18.7%(23/123)were Gram positive.The antibiotics with low resistance to Gram negative bacteria from bacterial liver abscess included Amikacin(0.0%),Ertapenem(0.0%),Imipenem(2.2%),Ceftazidime(4.4%),Cefepime(4.4%),Aztreonam(6.7%),Piperacillin Sodium/Tazobactam Sodium Tobramycin(8.9%),Cefotetan(8.9%),Levofloxacin(8.9%),Tobramycin(11.1%),etc.The antibiotics with low resistance to Gram negative bacteria from biliary tract infection included Amikacin(0.0%),Ertapenem(0.0%),Imipenem(4.2%),Piperacillin Sodium/Tazobactam Sodium(5.3%),Tobramycin(6.3%),etc.The proportions of the multidrug resistant strains in the two types of infection were 38.5%and 30.9%,respectively(P>0.05).Conclusion Gram negative bacteria are the main pathogens of the two infections.Klebsiella pneumonia is the most common bacteria in bacterial liver abscess,while Escherich ia coli is the most commo

关 键 词：肝脓肿 化脓性 胆管疾病 抗菌药 微生物敏感性试验 集落计数 微生物 胆道感染 

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