胆囊与胆管胆汁细菌培养及药敏分析的比较研究

The comparative study about biliary germiculture and antibiotic susceptibility test both in gallbladder and bile duct

目的探讨胆道感染者胆囊与胆管胆汁中的细菌分布、细菌培养阳性率及菌群对抗生素的敏感性。方法选择2005年6月至2007年10月住院手术的273例胆道感染患者的胆汁标本进行细菌培养及药敏试验分析,对培养结果阳性胆汁的细菌分布及药敏结果进行统计分析。结果273份胆汁标本中149例培养阳性,其中胆囊胆汁17例,培养阳性率为19.8%,胆管胆汁132例,培养阳性率为61.7%。共分离出G-杆菌127株,G+球菌74株,真菌0株。引起胆道感染的病原菌依次为大肠埃希氏菌、肠球菌、铜绿假单胞菌和葡萄球菌。药敏结果显示,G-杆菌对亚胺培南、美罗培南、头孢吡肟及丁胺卡那霉素耐药率最低,对氨苄西林、哌拉西林、头孢唑啉及复方新诺明高度耐药。G+球菌对替考拉宁、万古霉素及氯霉素耐药最低。结论胆道感染仍以G-杆菌占主要地位,但G+球菌感染呈现出明显上升势头。胆管胆汁细菌感染率较胆囊胆汁高,且细菌对临床常用抗生素的耐药性明显增加。

Objective To investigate the biliary pathogenic bacteria and their susceptibility to antibiotics of bile from gallbladder and bile duct in biliary tract infection patients. Methods The bile from 273 patients with biliary tract infection during June 2005 and Oct. 2007 were subjected to biliary gemiculture and sensitivity to antibiotics, and the results were statistically analyzed. Results The 149 patients with positive bile bacteria culture belonged to 17 of bile in gallbladder （ 19.8%, 17/273 ） and 132 of bile in bile duct （61.7% , 132/273 ）. A total of 201 strains were identified, including 127 Gram negative strains （63.2% , 127/201 ） , 74 Gram positive strains （36.8% , 74/201 ）, and no fungal strains were tested. The most common pathogenic bacteria were Escherichia eoli （37.8% , 76/201 ）, Enterocoecus （28.4%, 57/201 ）, Pseudornonas aeruginosa and Staphylococcus （each 8.5%, 17/201 ）. Drug sensitivity test indicated that Gram negative strains were sensitive to imipenem, meropenem, cefepime and amikacin, etc. , and so as Gram positive strains to vancomycin, teicoplanin and chloromycetin. Conclusion Gram negative strains remains the most common in biliary tract infection, but the rate of Gram positive is rising. The bacterio - infection rate of bile in bile duct is higher than in gallbladder.