急性胆道感染患者胆汁病原菌分布及耐药率变迁  

Pathogens′distribution and changes of antimicrobial resistance in the bile of acute biliary tract infection patients

作　　者：吴自友 吴向嵩[1] 姚文衍 王雪峰[1] 全志伟[1] 龚伟[1] Wu Ziyou;Wu Xiangsong;Yao Wenyan;Wang Xuefeng;Quan Zhiwei;Gong Wei(Department of General Surgery,Xinhua Hospital,Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai Key Laboratory of Biliary Tract Disease Research,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院普通外科,上海市胆道疾病研究中心,200092

出　　处：《中华外科杂志》2021年第1期24-31,共8页Chinese Journal of Surgery

摘　　要：目的探讨急性胆道感染患者胆汁病原菌分布和耐药率的变化趋势。方法回顾性分析2009年7月至2019年7月于上海交通大学医学院附属新华医院普通外科行胆囊穿刺或内镜下逆行胰胆管造影引流的223例急性胆道感染患者的临床资料,男性141例,女性82例,年龄67.3岁(范围:28~93岁)。每例患者抽取胆汁3~5 ml,送至检验科细菌培养室,对胆汁进行细菌培养、鉴定和药物敏感性试验。按照患者就诊时间分为前、后两组,前组(n=124)的收治时间为2009年7月至2014年7月,后组(n=99)的收治时间为2014年8月至2019年7月,对比两组患者的病原菌分布及常见细菌的耐药率变化趋势。采用WHO细菌监测网提供的WHONET软件对药物敏感性试验结果进行分析。不同时间段耐药率的比较采用χ^(2)检验。结果本研究包括急性胆管炎患者147例,急性胆囊炎患者76例,共培养出病原菌376株。其中革兰阳性菌98株(26.1%),革兰阴性菌269株(71.5%),真菌9株(2.4%)。革兰阳性菌中前3位为屎肠球菌(49.0%,48/98)、粪肠球菌(20.4%,20/98)、铅黄肠球菌(7.1%,7/98);革兰阴性菌中前5位为大肠埃希菌(33.5%,90/269)、肺炎克雷伯菌(13.8%,37/269)、铜绿假单胞菌(13.0%,35/269)、鲍曼不动杆菌(12.6%,34/269)、阴沟肠杆菌(4.8%,13/269)。2009年至2019年急性胆道感染患者胆汁中革兰阳性菌(前组∶后组为25.3%∶28.2%)与革兰阴性菌(前组∶后组为74.7%∶71.8%)的比例无明显变化。革兰阳性菌以肠球菌属(85.7%,84/98)为主,革兰阴性菌以大肠埃希菌(33.5%,90/269)为主。前组中鲍曼不动杆菌占革兰阴性菌比例为7.8%(11/142),后组为18.1%(23/127),比例较前5年上升10.3%;铜绿假单胞菌在前组中比例为16.9%(24/142),后组为8.7%(11/127),比例下降8.2%;其余菌株变化不显著。常见革兰阴性菌中,肺炎克雷伯菌对大部分抗菌药物的耐药率呈上升趋势(前组:0/15~4/13,后组:55.0%~70.0%;χ^(2)=3.996~16.942,P=0.000~0.046);鲍�Objective To investigate the pathogens′distribution and antimicrobial resistance in the bile of acute biliary tract infection patients.Methods The data of bile bacterial culture and drug sensitivity test of 223 acute biliary tract infection patients who underwent gallbladder puncture or endoscopic retrograde cholangiopancreatography drainage from July 2009 to July 2019 were analyzed retrospectively at Department of General Surgery,Xinhua Hospital,Affiliated to Shanghai Jiao Tong University School of Medicine.There were 141 males and 82 females with age of 67.3 years(range:28 to 93 years).Three to five milliliter of bile was extracted from each patient and sent to the laboratory for bacterial culture,identification and drug sensitivity test.The patients were divided into two groups according to the visiting time:the former group(n=124)was admitted from July 2009 to July 2014,and the latter group(n=99)was admitted from August 2014 to July 2019.The distribution of pathogenic bacteria and the changing trend of drug resistance rate of common bacteria in the two groups were compared.The results of drug sensitivity test were analyzed by WHONET software provided by WHO bacterial surveillance network.The drug resistance rates in different time periods were compared by χ^(2) test.Results In this study,there were 147 cases of acute cholangitis and 76 cases of acute cholecystitis.A total of 376 strains of pathogenic bacteria were cultured.Among them,98 strains(26.1%)were gram-positive bacteria,269 strains(71.5%)were gram-negative bacteria and 9 strains(2.4%)were fungi.The top three gram-positive bacteria were Enterococcus faecium(49.0%,48/98),Enterococcus faecalis(20.4%,20/98),and Enterococcus luteus(7.1%,7/98).The top 5 gram-negative bacteria were Escherichia coli(33.5%,90/269),Klebsiella pneumoniae(13.8%,37/269),Pseudomonas aeruginosa(13.0%,35/269),Acinetobacter baumannii(12.6%,34/269),and Enterobacter cloacae(4.8%,13/269).From 2009 to 2019,there was no significant change in the proportion of gram-positive bacteria(form

关 键 词：急性胆道感染 胆汁细菌培养 细菌谱 耐药率变迁 

分 类 号：R735.7[医药卫生—肿瘤]