上海市金山地区胆道感染患者胆汁细菌感染及耐药分析

Biliary bacteriology and drug resistance in patients with biliary tract infection in Jinshan area

目的 了解上海市金山地区近3年来胆道感染患者胆汁中细菌分布的特点及对抗生素的敏感性。方法收集2006年6月至2009年6月间367例胆石症合并胆道感染患者的胆汁标本作需氧菌培养及药敏试验，并对试验结果进行统计分析。结果胆汁培养阳性142例（38．7％），共培养出156株细菌，其中革兰阴性菌97株（62．2％）、革兰阳性菌51株（32．7％）、真菌8株（5．1％）。主要致病菌依次为肠球菌属（17．9％）、大肠埃希杆菌（12．8％）、葡萄球菌属（11．5％）、肺炎克雷伯杆菌（8．3％）、铜绿色假单胞菌（7．7％）等。混合感染率为18．3％。年龄≥60岁的患者胆汁培养阳性率为53．1％（X^2=8．36，P＜0．01）。急性胆道感染胆汁培养阳性率为47．1％（X^2=4．68，P＜0．05）。革兰阴性菌对美诺培南总耐药率最低（7．5％），其次为亚胺培南（8．8％）、头孢哌酮＋舒巴坦（19．7％）、阿米卡星（21．9％）、哌拉西林＋他唑巴坦（25．3％），对氨苄西林、喹诺酮类、部分三代头孢菌素表现出较高的耐药率（均〉50．0％）。革兰阳性菌对万古霉素总耐药率最低（0．0％），其次为磷霉素（11．3％）、氯霉素（11．6％），对青霉素、氨苄西林、左氧氟沙星、头孢噻肟钠、头孢唑啉等耐药性均很高（均〉40．0％）。结论肠球菌属、大肠埃希杆菌、葡萄球菌属、肺炎克雷伯杆菌是当前上海市金山地区常见的胆道感染致病菌，对该地区胆道细菌感染推荐使用头孢哌酮＋舒巴坦或哌拉西林＋他唑巴坦＋阿米卡星＋甲硝唑。亚胺培南、万古霉素可作为临床二线药物治疗其他药物治疗无效的重度胆道感染和难治性感染。

Objective To investigate the distribution of biliary bacteriology and their sensitivity to antibiotics in patients with biliary tract infection in Jinshan area in recent 3 years. Methods Bile specimens collected from 367 patients with cholelithiasis between June 2006 and June 2009 were cultured and tested for drug sensitivity to aerobic bacteria. The results were statistically analyzed. Results One hundred and fifty six bacterial strains were found in 142 （38. 7%） bile specimens including gram negative strains （97,62.2%）, gram positive strains （51 , 32.7%）, and fungal strains （8, 51%,）. Enterococcus （17. 9%） was major pathogen and follwed by Escherichia coli （12. 8%）, staphylococcus （11.5%）, Klebsiella pneumoniae （8.3%）, Pseudomonas aeruginosa （7.7%）. Whereas the mixed infection was found in 26 （18. 3%） specimens. The positive rate of bacterial infection was 53.1 % in patients over 60 years of age （X2 =8.36 ,P〈0.01） and 47.1 % in patients with acute biliary infeclion （X2 = 4. 68, P〈0. 05）. The drug susceptibility revealed that gram negative strains had low resistance to Meropenem （7.5% ）, and followed by Imipenem （8.8%）, Cefoperazone -Sulbactam （19.7%）, Amikacin （21.9%） and Tazobaetamq-Piperacillin （TZP, 25.3%）, but they were highly resistant to Ampieillin, Quinolones and some third generation of Cephalosporins （〉50%）. In gram positive strains, none was resistant to Vancomycin, 11. 3% to fosfomycin and 11. 6% to chloromycetin. They were highly resistant to Penicillins, Ampicillin and Cefazollin （〉 40%）. Conclusions Enterococcus, Escherichia coli , Sstaphylococcus and Klebsiella pneurnoniae are commonly seen pathogens in biliary tract infection in Jinshan area. Use of Sulperazone or TZP plus Amikacin and metronidazole is recommended. Imipenem and Vancomycins may he second choice in treatment of severe biliary infection and refractory infection.