不同类型胆囊结石患者感染致病菌特征及药物敏感性结果分析  

Analysis of Characteristics and Drug Susceptibility of Pathogenic Bacteria in Patients with Different Types of Gallstones

作　　者：杜国涛 王青 赵伟伟 孙悦 刘建中 DU Guo-tao;WANG Qing;ZHAO Wei-wei(Cangzhou People's Hospital,Hebei,Cangzhou(061000),China)

机构地区：[1]沧州市人民医院,沧州061000

出　　处：《中国中西医结合外科杂志》2020年第3期441-445,共5页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：沧州市重点研发计划指导项目(172302072)。

摘　　要：目的:分析不同类型胆囊结石患者胆汁中的致病菌种类及其耐药性,为胆囊结石的预防和治疗中抗菌药物的选择提供依据。方法:选取2016年10月-2018年10月在沧州市人民医院肝胆外科接受择期胆囊切除术的228例胆囊结石患者,获得其胆石及胆汁标本,对胆石患者进行分类,并且对从胆汁中分离出的致病菌及其耐药性进行分析。结果:228例患者中胆固醇结石106例,胆红素结石78例,混合型结石44例。对228例手术患者的胆汁进行细菌培养,其中80例呈阳性,阳性率为35.09%,80例中共培养出111株细菌,以革兰阴性菌为主,共有89株,占80.18%,革兰阳性菌共有20株,占18.02%,真菌2株,占1.80%。致病菌的药敏结果提示革兰阴性菌对亚胺培南、哌拉西林他唑巴坦、阿米卡星和头孢哌酮舒巴坦的耐药率较低;革兰阳性菌对万古霉素、氯霉素、左氧氟沙星和环丙沙星的耐药率较低。结论:胆囊结石患者常伴有明显的细菌感染,主要以革兰阴性菌为主、革兰阳性菌次之。在选择抗菌药物时,可以选择多种抗菌药物的联合应用,并根据患者的胆汁培养结果和药敏结果及时调整抗菌药物的应用。Objective To analyze the pathogenic bacteria and drug resistance of bile in patients with different types of gallstones,and to provide evidence for the selection of antibiotics in the prevention and treatment of gallstones.Methods 228 patients with cholecystolithiasis hospitalized in Cangzhou People's Hospital from October 2016 to October 2018 were chosen,with the isolated strains and their drug resistance retrospectively analyzed.Results 106 patients with cholesterol stones in 228 patients,78 patients with bilirubin stones,and 44 patients with mixed stones.Bile culture was carried out in 228 surgical patients,of which 80 cases were positive for bile culture,and the positive incidence was 35.09%.Among the 80 positive results,111 strains of bacteria were cultured,mainly Gram-negative(G-)bacteria,89 strains,accounting for 80.18%,and Gram-positive(G+)bacteria,20 strains,accounting for 18.02%,fungi 2 strains,accounting for 1.80%.G-bacteria have lower resistance rates to imipenem,piperacillin tazobactam,amikacin and cefoperazone sulbactam.G+bacteria have lower resistance rates to vancomycin,chloramphenicol,levofloxacin and ciprofloxacin.Conclusion Pati ents with gallstones are accompanied by bacterial infections.The main bacterial infections are G-bacteria and G+bacteria followed.A combination of a plurality of antibacterial drugs can be selected,and the application of the antibacterial drug can be adjusted in time according to the bile culture result and the drug sensitivity result of the patients.

关 键 词：胆囊结石 致病菌 抗菌药物 药物敏感性 

分 类 号：R657.42[医药卫生—外科学]