内镜逆行胰胆管造影术后胆道感染患者胆汁需氧菌及其药敏分析  

Analysis of bile aerobic bacteria in patients with biliary tract infection after endoscopic retrograde cholangiopancreatography and their drug susceptibility

作　　者：卢忠友 吴小微[1] 王计[1] 晏妮 张光燕 LU Zhong-you;WU Xiao-wei;WANG Ji;YAN Ni;ZHANG Guang-yan(Hanyang Hospital Affiliated to Wuhan University of Science and Technology,Wuhan,Hubei 430000,China)

机构地区：[1]武汉科技大学附属汉阳医院消化内科,湖北武汉430000

出　　处：《中华医院感染学杂志》2022年第3期439-442,共4页Chinese Journal of Nosocomiology

基　　金：武汉市科研基金资助项目(2019WH21109)。

摘　　要：目的 观察内镜逆行胰胆管造影(ERCP)术后胆道感染患者胆汁需氧菌及其药敏分析。方法 选取武汉科技大学附属汉阳医院消化内科2015年1月-2020年1月85例ERCP术后胆道感染患者作为研究对象,胆汁标本取自ERCP术中,根据胆汁细菌培养结果分为阳性组和阴性组,同时对需氧菌进行药敏与耐药基因分析。结果 85例患者中,胆汁培养阳性62例,阴性23例,阳性组患者血象异常例数高于阴性组(P<0.05);共检出需氧菌68株,其中革兰阴性菌51株占75.00%,革兰阳性菌17株占25.00%,以大肠埃希菌、肺炎克雷伯菌和粪肠球菌为主;粪肠球菌对青霉素G、左氧氟沙星的耐药率>40%,对万古霉素、呋喃妥因以及替考拉宁较敏感;大肠埃希菌和肺炎克雷伯菌对头孢唑林、头孢噻肟耐药率较高,均对亚胺培南、美罗培南以及替加环素较敏感;肠球菌属主要检出耐药基因为ant(4c,4d)、aac(6c)/aph(2d)、ant(2d)-Ⅰ、TEM、aph(3c)-Ⅲ;大肠埃希菌主要检出耐药基因为TEM、aac(6c)/aph(2d)、ant(6)-Ⅰ。结论 ERCP术后胆道感染患者胆汁需氧菌以革兰阴性菌为主,检测到的病原菌大多具有多药耐药性,药敏试验分析对临床合理使用抗菌药具有重要指导意义。OBJECTIVE To observe the bile aerobic bacteria in patients with biliary tract infection after endoscopic retrograde cholangiopancreatography(ERCP) and their drug susceptibility. METHODS A total of 85 patients with biliary tract infection after ERCP who were treated in the Department of Gastroenterology at Hanyang Hospital Affiliated to Wuhan University of Science and Technology from Jan 2015 to Jan 2020 were selected as the research subjects. The bile specimens were taken from ERCP operation and were divided into positive and negative groups according to the results of bile bacterial culture. Meanwhile, drug susceptibility and resistance genes of aerobic bacteria were analyzed. RESULTS Among the 85 patients, 62 cases were positive for bile culture, and 23 were negative, the number of abnormal hemograms in the positive group was significantly higher than that in the negative group(P<0.05). A total of 68 strains of aerobic bacteria were detected, of which 51 strains of Gram-negative bacteria accounted for 75.00%, and 17 strains of Gram-positive bacteria accounted for 25.00%, mainly Escherichia coli, Klebsiella pneumoniae and Enterococcus faecails. The resistance rates of E. faecalis to penicillin G and levofloxacin were higher than 40%, and it was more sensitive to vancomycin, nitrofurantoin and teicoplanin. The resistance rates of E. coli and K. pneumoniae to cefazolin and cefotaxime were higher, and both were more sensitive to imipenem, meropenem and tigecycline. The main drug resistance genes detected in E coccus were ant(4 c, 4 d), aac(6 c)/aph(2 d), ant(2 d)-Ⅰ, TEM, and aph(3 c)-Ⅲ. The main resistance genes detected in E. coli were TEM, aac(6 c)/aph(2 d), and ant(6)-Ⅰ. CONCLUSION Gram-negative bacteria was the main bile aerobic bacteria in patients with biliary tract infection after ERCP. Most of the pathogenic bacteria detected were multi-drug resistant. Sensitivity test analysis was of great guiding significance for rational use of antibiotics in clinical practice.

关 键 词：内镜逆行胰胆管造影 胆道感染 胆汁 需氧菌 药敏分析 

分 类 号：R445[医药卫生—影像医学与核医学]