胆道疾病感染菌群谱及药物敏感性分析  

作　　者：余毅群 楼国春[2] 

机构地区：[1]浙江省淳安县第一人民医院,311700 [2]浙江省人民医院,310014

出　　处：《浙江临床医学》2020年第12期1748-1750,共3页Zhejiang Clinical Medical Journal

基　　金：杭州市卫生科技计划项目(2018B081)。

摘　　要：目的研究本地区胆道感染患者胆汁菌群谱变化及各菌种对不同抗生素药敏试验结果,并指导临床合理用药。方法统计2017年1月至2019年12月间收诊的232例胆道疾病患者的胆汁细菌培养及抗菌药物敏感性试验结果。胆汁通过经内镜逆行性胰胆管造影(ERCP)或胆道手术获取。结果2017年至2019年三年间分别送检74份、65份和93份胆汁样本,胆汁培养分离得到致病菌株55株、46株和76株,其中革兰阴性杆菌所占构成比在三年间明显下降,而革兰阳性球菌则相对增多。对于本地区常见革兰阴性杆菌,厄他培南、亚胺培南敏感率最高,针对氨苄西林、部分喹诺酮类抗生素以及多数三代甚至四代头孢菌素的耐药性则较高。对于本地区常见革兰阳性球菌,万古霉素尚未发现耐药情况,环丙沙星、利奈唑胺及四环素具有较高敏感性,而红霉素类以及青霉素类抗生素则疗效较差。结论本地区胆道疾病感染菌群谱正在发生改变,其中革兰阳性菌感染率出现显著上升,临床治疗应结合药敏结果调整经验性抗感染用药方案,以降低病原菌耐药性,提高治愈率。Objective To study the changes of bile flora spectrum in patients with biliary tract disease in Chun'an area and the drug senstivity and resistance of various strains to a series of antibiotics,then to propose a method to guide clinical rational drug use.Methods The results of bile bacterial culture and antibiotic susceptibility test in 232 patients with biliary tract disease admitted from January 2017 to December 2019 were collected.Bile was obtained by ERCP or biliary surgery.Results From 2017 to 2019,74,65 and 93 bile samples were taken,55 strains,46 strains and 76 strains of pathogenic strains were isolated from bile culture.The composition ratio of Gram-negative bacilli decreased significantly in three years,while Gram-positive cocci increased.For the common Gram-negative bacilli in this region,ertapenem and imipenem were the most sensitive,followed by amikacin,co-trimoxazole and piperacillin.However,resistance to ampicillin,partial quinolone antibiotics,and most third-generation or even fourth generation cephalosporins was higher.For the common Gram-positive cocci in the region,vancomycin had not found drug resistance,linezolid and tetracycline had higher sensitivity,while erythromycin and perillin antibiotics were less ffective.Conclusion In this region,the bacterial flora of bilay tract infection is changing,among which the gram-positive bacterial infection rate is significantly increased.Clinical treatment should be combined with drug sensitivity results to adjust the experiential anti-infective drug regimen,so as to reduce the resistance of pathogenic bacteria and improve the cure rate.

关 键 词：胆道疾病 胆汁培养 菌群谱 药敏试验 

分 类 号：R44[医药卫生—诊断学]