老年急性胆道系统感染患者细菌性病原谱及耐药性分析  

Analysis of bacterial pathogen spectrum and drug resistance in elderly patients with acute biliary tract infection

作　　者：张光明 屈敏 郭坤 吕承秀 ZHANG Guang-ming;QU Min;GUO Kun(Department of General Surgery,Zibo First Hospital,Shandong Zibo 255200)

机构地区：[1]淄博市第一医院普外科,山东淄博255200 [2]淄博市第一医院检验科,山东淄博享255200 [3]淄博市分子免疫检验医学重点实验室,山东淄博255200

出　　处：《医学检验与临床》2024年第7期33-37,74,共6页Medical Laboratory Science and Clinics

摘　　要：目的:分析某三甲医院老年急性胆道系统感染患者的细菌性病原谱及耐药性。方法:选取2018年1月-2023年8月淄博市第一医院住院的226例老年急性胆道系统感染患者,留取患者的胆汁进行细菌培养鉴定、细菌性病原体的药敏试验和产ESBLs菌株的耐药基因检测。结果:226例老年急性胆道系统感染患者中139例患者检出细菌,占比61.50%,15例患者存在混合感染;患者中共检出细菌155株,其中大肠埃希菌(Escherichia coli,Eco)占比49.68%(77/155);肺炎克雷伯菌(Klebsiella pneumoniae,Kpn)占比14.19%(22/155);屎肠球菌占比13.55%(21/155);粪肠球菌占比4.52%(7/155)。Eco和Kpn中产ESBLs菌株占比分别为53.25%(41/71)和31.82%(7/22)。Eco中产ESBLs耐药基因为bla_(CTX-1group(1,3,15))、bla_(TEM)、bla_(ctx-3GROUP(9,14));Kpn中产ESBLs耐药基因为bla_(CTX-1group(1,3,15))、bla_(SHV)、bla_(TEM),两种菌中bla_(SHV)的阳性率存在差异(x^(2)=32.691,P<0.001)。结论:本地区老年急性胆道系统感染患者细菌性病原体以革兰阴性菌为主,且存在细菌性病原体混合感染;Eco中产ESBLs菌株常见,Eco和Kpn中产ESBLs耐药基因型别均以bla_(CTX-1group(1,3,15))为主。Objective:To analyze the bacterial pathogen spectrum and drug resistance of elderly patients with acute biliary tract infection in a tertiary hospital.Methods:226 elderly patients with acute biliary tract infection admitted to the First Hospital of Zibo City from January 2018 to August 2023 were selected,and their bile was collected for bacterial culture identification,bacterial pathogen sensitivity testing,and resistance gene testing of ESBLs producing strains.Results:Among 226 elderly patients with acute biliary tract infection,139 patients(61.50%)were found to have bacteria,and 15 patients had mixed infections;A total of 155 bacterial strains were detected in the patients,with Escherichia coli accounting for 49.68%(77/155);Klebsiella pneumoniae accounted for 14.19%(22/155);Enterococcus faecium accounted for 13.55%(21/155);Enterococcus faecalis accounted for 4.52%(7/155):The proportion of ESBLs producing strains in Escherichia coli was 53.25%(41/71).The proportion of ESBLs producing strains in Klebsiella pneumoniae was 31.82%(7/22)The ESBLs resistance genes produced by Escherichia coli were bla_(CTX-1group(1,3,15)),bla_(TEM)、bla_(ctx-3GROUP(9,14)).resistance genes produced by Klebsilla pneumoniae were bla _(CTX-1group(1,3,15)),bla_(SHV),bla_(TEM). There was a diference in the positive rate ofblasrv between the two bacteria(x^(2)=32.691,P<0.001).Conclusion:The pathogenic bacteria in elderly patients with acute biliary tract infection in this area are mainly gram negative bacteria,and there has mixed infection of pathogenic bacteria;Escherichia coli producing ESBLs strains are common,and the ESBLs resistant genotypes of Escherichia coli and Klebsiell pneumoniae are mainly bla _(CTX-1group(1,3,15)).

关 键 词：老年患者 急性胆道系统感染 病原谱 耐药性 耐药基因 

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