贵州地区胆道系统感染常见病原菌及其耐药性分析  

Analysis of common pathogens and drug resistance of biliary tract infections in Guizhou

作　　者：罗湘蓉[1] 许永杰 胡方芳[1] 李红凌[1] 张华[1] LUO Xiangrong;XU Yongjie;HU Fangfang;LI Hongling;ZHANG Hua(Department of Clinical Laboratory,Guizhou Provincial People′s Hospital,Guiyang,Guizhou 550002,China)

机构地区：[1]贵州省人民医院检验科,贵州贵阳550002

出　　处：《国际检验医学杂志》2020年第19期2332-2336,共5页International Journal of Laboratory Medicine

基　　金：贵州省卫生计生委科研项目(gzwjkj2016-1-069);贵州省人民医院国家自然科学基金补助基金(黔科合平台人才〔2017〕5724-6)。

摘　　要：目的分析贵州地区引起胆道感染的病原菌分布及耐药情况,为临床合理使用抗菌药物提供依据。方法对来自2014-2018年贵州省6家三级甲等医院怀疑胆道感染患者胆汁标本进行分离培养,采用全自动微生物分析仪进行鉴定与药敏实验。依据CLSI2018规则对药敏结果进行判读,数据采用WHONET5.6软件进行分析。结果剔除重复菌株,共分离出病原菌1778株,其中革兰阴性菌1417株(79.7%),革兰阳性球菌361株(20.3%)。前5位病原菌分别为大肠埃希菌772株(43.4%)、肺炎克雷伯菌242株(13.6%)、屎肠球菌170株(9.6%)、粪肠球菌122株(6.9%)、阴沟肠杆菌101株(5.7%)。大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)的阳性率分别为62.5%、48.6%。大肠埃希菌对碳青霉烯类抗菌药物、阿米卡星、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦的耐药率低(<20.0%)。革兰阳性球菌的耐药性:未检出对利奈唑胺、替加环素耐药的屎肠球菌和粪肠球菌,耐万古霉素的屎肠球菌(VREM)、耐万古霉素的粪肠球菌(VREF)检出率分别为0.6%、1.8%,粪肠球菌对喹诺酮类、氨苄西林的耐药率均小于10.0%,屎肠球菌对多数抗菌药物的耐药率高于粪肠球菌。结论胆道感染病原菌以大肠埃希菌、肺炎克雷伯菌等肠杆菌科细菌为主,其次为屎肠球菌、粪肠球菌。耐药细菌较多,应重视胆汁标本培养及药敏试验。Objective To investigate the distribution and drug resistance of biliary culture bacteria in patients with biliary tract infection in Guizhou and to provide evidence for the rational use of antimicrobial drug.Methods Bile specimens from suspected biliary tract infections in six third-grade class A hospitals in Guizhou Province from 2014 to 2018 were isolated and cultured.Identification and susceptibility test were carried out by automatic microbiological analyzer.According to CLSI 2018 rule,the results of drug sensitivity were interpreted,and the data were analyzed by using WHONET 5.6 software.Results After removing the repeated strains,a total of 1778 strains of pathogenic bacteria were isolated,including 1417 Gram-negative bacteria(79.7%)and 361 Gram-positive bacteria(20.3%).The top five pathogens were 772 strains of Escherichia coli(43.4%),242 strains of Klebsiella pneumoniae(13.6%),170 strains of Enterococcus faecalis(9.6%),122 strains of Enterococcus faecalis(6.9%)and 101 strains of Enterococcus cloacae(5.7%).The positive rates of ESBLs by Escherichia coli and Klebsiella pneumoniae were 62.5%and 48.6%,respectively.Escherichia coli had low resistance to carbapenems,amikacin,piperacillin/tazobactam,cefoperazone/sulbactam(<20.0%).Enterococcus faecium and Enterococcus faecalis had no resistance to linezolid and tigecycline.The detection rates of vancomycin resistant Enterococcus faecium(VREM)and vancomycin resistant Enterococcus faecalis(VREF)were 0.6%and 1.8%,respectively.The resistance rates of Enterococcus faecalis to quinolones and ampicillin were less than 10.0%.The resistance rate of Enterococcus faecium to most antibiotics was higher than that of Enterococcus faecalis.Conclusion Enterobacteriaceae such as Escherichia coli and Klebsiella pneumoniae are the main pathogens of biliary tract infection,followed by Enterococcus faecalis and Enterococcus faecalis.There are many drug-resistant bacteria,and attention should be paid to the culture of bile specimens and drug susceptibility tests.

关 键 词：胆道系统感染 病原菌 耐药性 贵州 

分 类 号：R575.7[医药卫生—消化系统] R446.5[医药卫生—内科学]