外科胆道感染病原菌分布及耐药性分析

Analysis of pathogen distribution and antimicrobial resistance in biliary tract infection in surgery

目的了解外科胆道感染的常见致病菌及对抗生素的耐药性，以指导临床用药。方法回顾性分析2003-2008六年间接受胆道手术的患者在术中所取胆汁进行培养的致病菌及药敏结果。结果从200例培养阳性的标本中检出病原菌229株，包含了43个菌种。革兰阴性杆菌75．1％，革兰阳性球菌24．0％，混合感染为13．0％。其中大肠埃希菌35．4％（81／229）居首位，其次为肠球菌属14．4％。大肠埃希菌ESBLS阳性率达44．4％（36／81），克雷伯菌属ESBLS阳性率16．6％（4／24）。细菌对抗生素多重耐药，革兰阴性杆菌对亚胺培南高度敏感，对阿米卡星和β-内酰胺酶抑制剂复合制剂敏感性也较高；革兰阳性球菌对万古霉素仍保持较高敏感性。结论胆道感染病原菌中以大肠埃希菌为主，肠球菌属居第二，大肠埃希菌ESBLS阳性率较高，胆道感染细菌多重耐药严重。

Aim To investigate the clinical distribution and drug resistance of bacilli isolated from biliary tract infection of surgery so as to guide the rational use of antibiotics. Methods We analyzed the distribution and bacterial resistance profile of 200 strains of bacterial isolates which were collected by surgery from biliary tract infection from January 2003 to November 2008 retrospectively. Results A total of 229 strains of bacterial isolates were found in 200 patients with positive bile culture, which belonged to 43 species ： Gram negative bacilli accounted for 75.1% , Gram positive cieci bacteria 24.8 % and multiple-bacteria 13 %. E. coil （35.4% , 81/229 ）was the most common pathogen,intestinal cocci accounted for 14.4%. The E. coil which produced ESBLS accounted for 44.4% （36/81）. The Klebsiella which produced ESBLS accounted for 16.6% （4/24）. The bacteria showed multiple-resistance. Gram negative bacilli were highly sensitive to imipenem and kept high sensitivity to amikacin and Pip/Tazo. Gram positive cicci bacteria were highly sensitive to vancomycin. Conclusions The main pathogens of biliary tract infection are E. coil and intestinal cocci. The presence of ESBLS is higher in E. coil. The bacteria show multiple -resistance in high levels.