胆汁标本病原菌学及药敏试验结果分析对恶性梗阻性黄疸合并感染患者抗菌药物合理使用的影响  

Analysis of pathogenic bacteria of bile specimens and analysis of drug sensitivity test results on the ratio-nal use of antibiotics in patients with malignant obstructive jaundice and infection

作　　者：赵静 李茉莉 高瑞 Zhao Jing;Li Moli;Gao Rui(Department of Laboratory Medicine,Lankao County Central Hospital,Henan475300,China;Department of Laboratory Medicine,Kaifeng Central Hospital,Henan 475000,China;Department of Blood Transfusion,Kaifeng Central Hospital,Henan 475000,China)

机构地区：[1]河南省兰考县中心医院检验科,475300 [2]河南省开封市中心医院检验科,475000 [3]河南省开封市中心医院输血科,475000

出　　处：《中国药物与临床》2022年第6期560-563,共4页Chinese Remedies & Clinics

摘　　要：目的探究胆汁标本病原菌学及药敏试验结果分析对恶性梗阻性黄疸并感染患者抗菌药物合理使用的影响。方法选取兰考县中心医院146例恶性梗阻性黄疸合并感染患者(2019年1月至2021年3月)作为研究对象,采集其胆汁标本,实行细菌培养、药敏试验,统计病原菌构成情况,并分析主要病原菌的耐药性。结果146例恶性梗阻性黄疸并感染患者共分离出162株病原菌,其中30株(18.5%)革兰阳性菌,以粪肠球菌(13株,8.0%)、屎肠球菌(10株,6.2%)为主;126株(77.8%)革兰阴性菌,以大肠埃希菌(72株,44.4%)、肺炎克雷伯菌(20株,12.4%)、铜绿假单胞菌(16株,9.9%)为主;6株(3.7%)真菌;粪肠球菌、屎肠球菌对青霉素、氨苄西林、红霉素、左氧氟沙星具有较高耐药性,对环丙沙星、氯霉素耐药性较低,对利奈唑胺、万古霉素、替考拉宁无耐药性;大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌对氨曲南、头孢唑林、左氧氟沙星具有较高耐药性,对亚胺培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、美罗培南及阿米卡星耐药性较低。结论恶性梗阻性黄疸合并感染患者胆汁内有多种病原菌,革兰阴性菌为主要病原菌,且病原菌间耐药性不同,对胆汁实施细菌培养、药敏试验可明确患者病原菌类型及对抗菌药物的敏感性,有助于临床合理用药,提高治疗效果。Objective To investigate the value of microbial culture and drug susceptibility test of bile specimens in rational use of antibacterials among patients with malignant obstructive jaundice and infection.Methods Included in this study were 146 patients with malignant obstructive jaundice and infection in our hos-pital between January 2019 and March 2021.Bile samples were collected and subjected to microbial culture and drug sensitivity test.The composition and proportions of pathogens were recorded.Drug resistance of the predomi-nating pathogens were analyzed.Results A total of 162 pathogenic strains were isolated from the 146 patients with malignant obstructive jaundice and infection,comprising 30(18.5%)strains of Gram-positive bacteria pre-dominated by enterococcus faecalis(13,8.0%)and enterococcus faecium(10,6.2%),and 126(77.8%)strains of gram-negative bacteria predominated by escherichia coli(72,44.4%),klebsiella pneumoniae(20,12.4%),and pseu-domonas aeruginosa(16,9.9%).There were 6 strains(3.7%)of fungi.The strains of e.faecalis and e.faeci-um were high-resistant to penicillin,ampicillin,erythromycin,and levofloxacin,low-resistant to ciprofloxacin and chloram-phenicol,and sensitive to linezolid,vancomycin and teicoplanin.The strains of e.coli,p.aeruginosa,and k.pneumoniae were high-resistant to aztreonam,cefazolin and levofloxacin,and low-resistant to imipenem,cef-opera-zone/sulbactam,piperacillin/tazobactam,meropenem,and amikacin.Conclusion There are a variety of pathogens in bile samples from patients with malignant obstructive jaundice and infection.Gram-negative bacteria are the predominating pathogens.The drug resistance differs among these pathogens.Implementation of microbial culture and drug sensitivity test of the bile samples can help determining the pathogens and their sensitivity to an-tibacterial drugs,promote rational use of antibacterial drugs in clinical settings,and improve the therapeutic efficacy.

关 键 词：黄疸 阻塞性 微生物敏感性试验 胆汁 

分 类 号：R446.5[医药卫生—诊断学] R735[医药卫生—临床医学]