161例胆道结石合并急性胆道感染患者的病原菌学及抗菌治疗分析  

Pathogenic Bacteriology and Antimicrobial Treatment of 161 Patients with Biliary Calculi Complicated by Acute Biliary Tract Infection

作　　者：林丹 廖琳丹 刘智强[1] 胡克章[1] 高燕 罗雨蕉 陈文婷 谢小芳 苏碧川[1] 罗玲艳 唐静[1] LIN Dan;LIAO Lindan;LIU Zhiqiang;HU Kezhang;GAO Yan;LUO Yujiao;CHEN Wenting;XIE Xiaofang;SU Bichuan;LUO Lingyan;TANG Jing(Department of Pharmacy,the First People's Hospital of Neijiang City,Neijiang 641000,China)

机构地区：[1]内江市第一人民医院药剂科,内江641000

出　　处：《医药导报》2025年第5期770-777,共8页Herald of Medicine

基　　金：内江市科技计划项目(Z202226)。

摘　　要：目的对胆道结石合并急性胆道感染患者的胆汁及血培养病原菌分布、耐药性以及基于药物敏感试验结果的临床抗菌药物使用合理性进行分析,为该类患者抗菌药物经验性治疗提供参考。方法回顾性统计2017—2023年在内江市第一人民医院收治的161例胆道结石合并急性胆道感染患者的临床资料,分析微生物培养结果、药物敏感试验数据及患者特征,评价临床抗菌药物治疗的合理性。结果161例病原菌培养阳性的患者共检测出病原菌212株,主要为大肠埃希菌、肺炎克雷伯杆菌肺炎亚种、屎肠球菌。年龄和基础疾病对大肠埃希菌和肺炎克雷伯杆菌的分布影响差异有统计学意义。革兰阴性菌中,大肠埃希菌和肺炎克雷伯杆菌肺炎亚种对常用的广谱青霉素、第3代头孢菌素、喹诺酮类耐药率较高,对哌拉西林他唑巴坦耐药率低;65岁及以上老年人群大肠埃希菌对头孢曲松耐药率较65岁以下人群高,有药物暴露史人群对头孢他啶耐药率较高。革兰阳性菌中,粪肠球菌对大多数抗菌药物耐药率低,屎肠球菌耐药率则较高,两者对万古霉素和替加环素的耐药率均为零,这可能与研究中肠球菌样本量偏小有关。161例患者经验性抗感染用药和目标抗感染用药合理率均不高,主要表现在抗菌药物联用不适宜、药物用法用量不适宜。结论胆道结石合并急性胆道感染患者胆汁及血培养病原菌以革兰阴性菌为主,其次是革兰阳性菌和真菌,厌氧菌感染也不容忽视。革兰阴性菌对大部分抗菌药物耐药率均较高,革兰阳性菌对万古霉素敏感,整体抗菌药物使用合理性较差。临床在胆道结石伴急性胆道感染治疗中应加强对病原微生物的检验,临床药师应加强对临床医生进行抗感染药物的培训,协助临床根据药物敏感试验结果合理选择抗菌药物,以预防多重耐药菌的产生。Objective To analyze the distribution and drug resistance patterns of pathogenic bacteria in bile and blood cultures obtained from patients with biliary stones accompanied by acute biliary tract infection,to evaluate the clinical appropriateness of antibiotic use based on drug sensitivity results,and to provide evidence for empirical antibiotic treatment in such patients.Methods The clinical data of 161 patients with biliary calculi complicated by acute biliary tract infection who were admitted to the First People's Hospital of Neijiang from 2017 to 2023 were retrospectively analyzed.The results of microbial culture,drug sensitivity analysis,and patient characteristics were assessed to evaluate the appropriateness of clinical antimicrobial therapy.Results Among the 161 patients with positive cultures,212 strains of pathogenic bacteria were detected.The predominant pathogens were Escherichia coli,Klebsiella pneumoniae subspecies,and Enterococcus faecium.Age and underlying diseases significantly affected the distribution of Escherichia coli and Klebsiella pneumoniae subspecies.Within the gram-negative bacterial group,Escherichia coli and Klebsiella pneumoniae subspecies exhibited higher drug resistance to commonly used broad-spectrum penicillin,third-generation cephalosporin and quinolones but lower resistance rates to piperacillin and tazobactam;furthermore,elderly individuals aged≥65 years showed higher resistance rates to ceftriaxone than those under age 65 while people with drug exposure history had higher ceftazidime resistance rates that were statistically significant.In contrast to Enterococcus faecalis which displayed low antimicrobial resistance rates for most drugs tested in this study,Enterococcus faecium demonstrated high levels of antibiotic resistance;however,both Enterococcus faecalis and Enterococcus faecium exhibited zero-resistance rates against vancomycin and tigecycline although this may be attributed to their small sample size in our study cohort.Finally,we found that empirical anti-infective

关 键 词：抗菌药物 胆道结石 胆道感染 急性 耐药性 

分 类 号：R978[医药卫生—药品] R575.7[医药卫生—药学]