胆道感染的病原菌分布及耐药性分析

Distribution and Drug Resistance of Pathogens Causing Biliary Tract Infection

目的了解胆道感染的病原菌分布及对抗菌药物的耐药性,为临床合理用药提供依据。方法将胆道感染患者的胆汁标本进行细菌培养、鉴定及药敏试验,对结果进行统计分析。结果共分离出364株病原菌,其中革兰阴性杆菌242株,占66.5%,主要为大肠埃希菌(26.1%)、肺炎克雷伯菌(8.3%)、阴沟肠杆菌(7.4%)、铜绿假单胞菌(6.9%);革兰阳性球菌120株,占33.0%,主要为粪肠球菌(13.0%)、屎肠球菌(9.6%)、葡萄球菌属(6.6%);药敏结果显示,革兰阴性杆菌对亚胺培南、美罗培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢吡肟的耐药率较低(0～29.5%),对青霉素类、喹诺酮类、氨曲南耐药率较高(33.3%～88.9%);革兰阳性球菌对万古霉素、替考拉宁敏感率为100.0%,对青霉素类、喹诺酮类、大环内酯类等耐药率较高(38.3%～85.7%)。结论胆道感染主要以革兰阴性杆菌为主,病原菌分布广,耐药严重,应加强病原菌和耐药性监测,以提高治疗成功率。

OBJECTIVE To understand the pathogenic distribution of biliary tract infections and antibiotic resistance and provide bases for rational application of antibiotics in clinics.METHODS The biliary infection bile specimens were collected for aerobic bacteria culture,then the identification and susceptibility test was performed and the statistical analysis was carried out to the results.RESULTS A total of 364 strains were isolated,from which Gram-negative bacilli were 242 strains,accounted for 66.5%,mainly were Escherichia coli（26.1%）,Klebsiella pneumoniae（8.3%）,Enterobacter cloacae（7.4%）,and Pseudomonas aeruginosa（6.9%）;while Gram-positive bacteria were 120 strains,accounted for 33.0%,mainly were Enterococcus（13.0%）,E.faecium（9.6%） and Staphylococcus（6.6%）;drug susceptibility results showed that the drug resistant rates of Gram-negative bacilli to imipenem,meropenem,piperacillin/tazobactam,cefoperazone/sulbactam and cefepime were relatively low（0.0-29.5%）,but to quinolones and aztreonam were high（33.3-88.9%）;Gram-positive cocci were 100.0% sensitive to vancomycin and teicoplanin,but their drug resistant rates to quinolones and macrolide were high（38.3-85.7%）.CONCLUSION Biliary tract infection is primarily caused by Gram-negative bacilli.Because of the wide distribution of pathogens and serious drug resistance,the monitoring of bacterial resistance should be enhanced to improve the cure rate.