急性胆管炎大肠埃希菌的耐药性及相关临床特征分析  

作　　者：郝素平 顾蓓青[1] 郝建宏[1] 

机构地区：[1]浙江省海宁市人民医院,314400

出　　处：《浙江临床医学》2024年第3期378-380,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省卫生健康科技计划项目(2022KY393)。

摘　　要：目的 分析急性胆管炎患者的大肠埃希菌耐药性及相关临床特征,为初始选择抗菌方案提供参考。方法 收集2019年1月至2022年12月305例急性胆管炎患者胆汁标本的病原菌培养结果和临床资料,分析大肠埃希菌的耐药性及相关临床特征。结果 305例患者中共分离出大肠埃希菌64株(21.12%),其中产ESBLs的大肠埃希菌约占42.19%。大肠埃希菌对替加环素、阿米卡星敏感性最好;对常用抗生素(除哌拉西林他唑巴坦、头孢哌酮舒巴坦外)耐药率较高,尤其是产ESBLs菌株(P<0.05)。既往胆道手术史、肝硬化是发生急性胆管炎大肠埃希菌感染的独立危险因素(P<0.05);而既往有胆道手术史患者的胆汁标本中更易检测出产ESBLs的大肠埃希菌(P<0.05)。结论 大肠埃希菌是急性胆管炎主要致病菌,其耐药率较高,尤其是产ESBLs者。既往胆道手术史、肝硬化与大肠埃希菌引起的急性胆管炎有关,而既往有胆道手术史患者的胆汁标本中,更易检测出产ESBLs大肠埃希菌,这一信息有助于选择急性胆管炎的初始抗菌药物。Objective To analyze the drug resistance and related clinical characteristics of Escherichia coli in patients with acute cholangitis,and provide reference for the initial selection of antimicrobial programs.Methods The pathogen culture results and clinical data of bile samples from 305 patients with acute cholangitis in the Department of hepatobiliary Surgery of Haining People's Hospital hospital during 2019-2022 were collected,and the drug resistance and related clinical characteristics of Escherichia coli were analyzed.Results A total of 64 Escherichia coli strains(21.12%,64/303)were isolated from 305 patients,among which ESBLS-producing Escherichia coli accounted for 42.19%(27/64).Escherichia coli had the best sensitivity to tigecycline and amikacin.The resistance rate to common antibiotics(except piperacillin,tazobactam and cefoperazone and sulbactam)was higher,especially in ESBLS producing strains(P<0.05).Previous biliary operation history and cirrhosis were the independent risk factors for Escherichia coli infection(P<0.05).Esbls-producing Escherichia coli was more easily detected in bile samples of patients with a history of biliary surgery(P<0.05).Conclusion Escherichia coli is the main pathogen of acute cholangitis,and its drug resistance rate is high,especially for ESBLs producers.Acute cholangitis caused by Escherichia coli is associated with previous biliary surgery and cirrhosis,and Esbls-producing Escherichia coli is more easily detected in bile samples of patients with acute cholangitis with previous biliary surgery.This information is helpful for the selection of initial antimicrobials in patients with acute cholangitis.

关 键 词：急性胆管炎 大肠埃希菌 抗菌药物 耐药性 临床特征 

分 类 号：R446.5[医药卫生—诊断学] R575.7[医药卫生—临床医学]