舟山海岛地区胆道感染病原菌及抗菌药物敏感性研究

Bacterial Distribution in Inpatients with Biliary Duct Infection and Antibiotics Sensitivity

目的分析舟山市胆道疾病患者胆汁培养病原菌及对抗菌药物的敏感性,以指导胆道感染性疾病的抗菌药物使用。方法收集浙江省舟山市4所医院自2007年1月-2009年8月胆汁标本培养结果资料共1430份,分类汇总并分析数据。结果 1430份胆汁培养有细菌生长584份,阳性率为40.84%,分离出菌株469株,以革兰阴性菌为主,占83.58%,主要由大肠埃希菌、克雷伯菌属和肠杆菌属构成,排于前4位的依次为大肠埃希菌、肺炎克雷伯菌、粪肠球菌、阴沟肠杆菌;抗菌药物敏感试验中亚胺培南(82.14%～100.00%)、美罗培南(57.14%～100.00%)、哌拉西林/他唑巴坦(54.55%～100.00%)、阿莫西林/克拉维酸(9.09%～88.89%)、阿米卡星(45.45%～100.00%)、奈替米星(21.43%～100.00%)、头孢西丁(6.89%～83.33%)、头孢他啶(29.63%～59.26%)及头孢吡肟(35.38%～82.76%)等敏感率优于阿莫西林(0～11.67%)、替卡西林(0～29.63%)、头孢噻吩(18.46%～35.00%)、头孢呋辛(22.22%～35.00%)、环丙沙星(18.46%～100.00%)等。结论胆石症患者胆汁细菌分布均以革兰阴性菌为主,哌拉西林/他唑巴坦、阿莫西林/克拉维酸、阿米卡星、奈替米星的敏感性较高,且对各类细菌均有效;头孢西丁针对大肠埃希菌及肺炎克雷伯菌敏感性较好,对其他革兰阴性菌则次于头孢他啶及头孢吡肟。

OBJECTIVE To observe the changes bacterial distribution in bile duct infection and the antibiotics sensitivity.METHODS The data of bile bacterial culture were studied in 1430 patients and the medicine antibiotics sensitivity was statistically analyzed.RESULTS From them 584 positive cultures from the bile were found（40.84%）.Totally 469 strains of pathogens were found and they consisted of 37 kinds of bacteria and five kinds of fungi.The first four were Escherichia coli,Klebsiella pneumoniae,Enterococcus faecalis and Enterobacter cloacae,which constituted 80.00% of the biliary bacteria.They were highly sensitive to imipenem（82.14-100.00%）,meropenem（57.14-100.00%）,piperacilin/tazobatam（54.55-100.00%）,amoxicillin/clavulanic acid（9.09-88.89%）,netilmicin（21.43-100.00%）,amikacin（45.45-100.00%）,cefoxitin（6.89-83.33%）,ceftazidime（29.63-59.26%）,and cefepie（35.38-82.76%）,while less sensitive to the first generation cephalosporins（18.46-35.00%）,amoxicillin（0-11.67%）,and ciprofloxacin（18.46-100.00%）.CONCLUSION The main microbial are consist of Gram-negative bacilli.E.coli,K.pneumoniae,E.faecalis and E.cloacae.Piperacillin/tazobatam,netilmicin,amikacin,cefoxitin,ceftazidime,and cefepime are the first choice.