200例胆石症合并胆道感染患者的病原菌分布、耐药性及危险因素分析  

Analysis of pathogens,their drug resistance,and risk factors in 200 patients with cholelithiasis and a biliary tract infection at this Hospital

作　　者：黄锦荣 肖吓鹏[1] 郑赟 李翰城[1] 廖乘龙[1] HUANG Jin-rong;XIAO Xia-peng;ZHENG Yun;LI Han-cheng;LIAO Cheng-long(GeneralSur-gery,NingdeMunicipalHospital,Ningde,Fujian,China352100)

机构地区：[1]宁德市医院普外科,福建宁德352100

出　　处：《中国病原生物学杂志》2020年第3期332-334,338,共4页Journal of Pathogen Biology

摘　　要：目的检测胆石症合并胆道感染患者的病原菌分布情况及其耐药性,分析其发病的危险因素,为感染的控制及合理用药提供参考。方法选取本院2016年8月至2019年2月收治并行手术治疗的胆石症合并胆道感染的患者200例,检测其胆汁中病原菌并进行耐药性试验;统计患者的性别、年龄、既往胆石症史、结石数、手术时间等信息,分析其与胆道感染的相关性。结果200例胆石症合并胆道感染患者的胆汁标本病原菌培养阳性163例,阳性率为81.5%。共培养出病原菌188株,其中革兰阴性菌(G-)142株,占75.5%;革兰阳性菌(G+)41株,占21.8%;真菌5株,占2.7%。G-菌中以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌多见,3种菌对阿莫西林、氨苄西林舒巴坦、氨曲南、头孢唑啉、庆大霉素等11种抗菌药物的耐药率为11.1%~100%,对哌拉西林他唑巴坦、阿米卡星、头孢替坦、厄他培南的耐药率为0~8.1%。G+菌中以粪肠球菌和屎肠球菌多见,2种菌对青霉素G、氨苄西林、克林霉素、左氧氟沙星等8种抗菌药物的耐药率为16.7%~90.5%,对利奈唑烷、替加环素、万古霉素均敏感。单因素分析显示,年龄、既往胆结石史、结石数、手术时间是胆石症合并胆道感染发生的危险因素(P<0.05)。结论胆石症合并胆道感染的致病菌菌谱广且存在一定的耐药性,明确病原菌分布及其耐药性有利于临床合理使用药物进行治疗;感染的发生与高龄、既往胆结石史、较多的结石数和较长的手术时间等因素相关,可为该病的预防和控制提供参考。Objective To detect the distribution and drug resistance of pathogenic bacteria in patients with cholelithiasis and a biliary tract infection,to analyze the risk factors for disease,and to provide a reference for infection control and rational drug use.Methods Subjects were 200 patients with cholelithiasis and a biliary tract infection who underwent surgery from August 2016 to February 2019.Bile was tested for pathogens,and a drug sensitivity test was performed.Information including sex,age,history of cholelithiasis,number of stones,and operating time was analyzed using univariate analysis.Results Of 200 patients with cholelithiasis and a biliary tract infection,163 had bile samples that tested positive for pathogens at a rate of 81.5%.One hundred and eighty-eight strains of pathogens were cultured,including 142 strains of Gram-negative bacteria(75.5%),41 strains of Gram-positive bacteria(21.8%),and 5 strains of fungi(2.7%).Escherichia coli,Klebsiella pneumoniae,and Pseudomonas aeruginosa were the most common Gram-negative bacteria.The resistance of those three strains to amoxicillin,ampicillin sulbactam,aztreonam,cefazolin,gentamicin,and other 11 antibacterials was 11.1-100%,and the resistance of those 3 strains to piperacillin,tazobactam,amikacin,cefotetan,and ertapenem was 0-8.1%.Enterococcus faecalis and E.faecalis were the most common Gram-positive bacteria.The resistance of those two strains to penicillin G,ampicillin,clindamycin,levofloxacin,and 11 other antibacterials was 16.7-90.5%,and those 2 strains were sensitive to linezolid,tigecycline,and vancomycin.Univariate analysis indicated that,age,a history of gallstones,the number of gallstones,and operating time were risk factors for gallstones and a biliary tract infection(P<0.05).Conclusion Pathogens were widely found in patients with cholelithiasis and a biliary tract infection and had a certain level of drug resistance.Determining the distribution and drug resistance of pathogens is conducive to rational and effective use of drugs in clinical treatment

关 键 词：胆石症 胆道感染 病原菌分布 耐药试验 危险因素 

分 类 号：R378[医药卫生—病原生物学]