胆囊结石伴胆囊炎患者胆汁中病原菌的特点及耐药性分析  

Characteristics and drug resistance of pathogenic bacteria in the bile of patients with gallbladder stones and cholecystitis

作　　者：张涛[1] 石庆龙[1] 王红禄[1] ZHANG Tao;SHI Qing-long;WANG Hong-lu(Department of General Surgery,Beijing Liangxiang Hospital,Capital Medical University,Beijing102401,China)

机构地区：[1]北京市房山区良乡医院普通外科,北京102401

出　　处：《中国当代医药》2021年第19期68-71,共4页China Modern Medicine

摘　　要：目的探讨胆囊结石伴胆囊炎患者胆汁中病原菌的特点及耐药性。方法选取2017年6月—2020年6月北京市房山区良乡医院接诊的182例胆囊结石伴胆囊炎患者作为研究对象,分析其胆汁中病原菌的特点与主要病原菌的耐药性。结果共检出病原菌191株,其中革兰氏阴性菌130株(68.06%),革兰氏阳性菌53株(27.75%),真菌8株(4.19%)。阴沟肠杆菌对氨苄西林/头孢唑林、氨苄西林/舒巴坦天然耐药;肺炎克雷伯菌对氨苄西林、头孢呋辛、头孢曲松天然耐药;大肠埃希菌对氨苄西林/舒巴坦、头孢噻肟、氨苄西林、头孢唑林、头孢呋辛、头孢曲松、哌拉西林耐药率均>50%;阴沟肠杆菌对氨曲南、头孢他啶、头孢噻肟、头孢呋辛、头孢曲松、阿莫西林克拉维酸钾、呋喃妥因耐药率均>60%;肺炎克雷伯菌对常见抗菌药物耐药率均<40%;主要革兰氏阴性菌对美罗培南、亚胺培南、阿米卡星的耐药率均<10%;粪肠球菌对氨苄西林、呋喃妥因耐药率为0%,主要革兰氏阳性菌对利奈唑胺、万古霉素、替加环素耐药率均为0%,对克林霉素、红霉素耐药率均>85%,其中屎肠球菌对利福平耐药率>85%。结论胆囊结石伴胆囊炎胆汁培养以革兰氏阴性菌感染为主,不同病原菌耐药性存在明显差异,临床需按照药敏结果合理选择抗生素,提高治疗效果,警惕多重耐药菌的出现。Objective To investigate the characteristics and drug resistance of pathogenic bacteria in the bile of patients with gallbladder stones and cholecystitis.Methods A total of 182 patients with gallbladder stones and cholecystitis who were admitted to Beijing Liangxiang Hospital from June 2017 to June 2020 were selected as the research objects and the characteristics of pathogenic bacteria in their bile and the drug resistance of the main pathogens were analyzed.Results A total of 191 pathogenic bacteria were detected,including 130 Gram-negative bacteria(68.06%),53 Gram-positive bacteria(27.75%),and 8 fungi(4.19%).Enterobacter Cloacae was naturally resistant to Ampicillin/Ceftazolin,Ampicillin/Sulbactam.Klebsiella Pneumoniae was naturally resistant to Ampicillin,Cefuroxime and Ceftriaxone.The resistance rates of Escherichia Coli to Ampicillin/Sulbactam,Cefotaxime,Ampicillin,Cefazolin,Cefuroxime,Ceftriaxone and piperacillin were>50%.The resistance rates of Enterobacter Cloacae resistant to Aztreonam,Ceftazidime,Cefotaxime,Cefuroxime,Ceftriaxone,Amoxicillin,Clavulanate Potassium and Nitrofurantoin were all>60%.Klebsiella Pneumoniae resistance to common antibacterial drugs was less than 40%.The drug resistance rates of the main Gram-negative bacteria to Meropepenem and Amikacin were all less than 10%.The resistance rates of Enterococcus Faecalis to Ampicillin and nitrofurantoin were 0%.The main Gram-positive bacteria resistant to Linezolid,Vancomycin and Tigecycline,the rates were all 0%,and the resistance rates to Clindamycin and Erythromycin were both>85%.The resistance rate of Enterococcus Faecium to Rifampin was>85%.Conclusion Bile culture of gallbladder stones with cholecystitis is mainly infected by gram-negative bacteria.There are obvious differences in drug resistance of different pathogens.It is necessary to select antibiotics reasonably according to the results of drug susceptibility,improve the therapeutic effect,and be alert to the emergence of multi-drug resistant bacteria.

关 键 词：胆囊炎 胆囊结石 病原菌特点 耐药性 

分 类 号：R575.62[医药卫生—消化系统]