5年胆道感染患者胆汁中病原菌的分布及耐药性分析

Distribution and drug resistance of pathogenic bacteria from bile of patients with biliary tract infections in 5 years

目的分析2005-2009年胆道感染患者胆汁中病原菌的分布及其耐药性变化。方法无菌操作收集5年胆道感染患者的391份胆汁进行培养,对分离出的病原菌进行鉴定和药物敏感试验。结果 391份标本中有215份阳性,共检出265株病原菌,检出率为55.0%,其中革兰阴性菌182株,占68.7%,革兰阳性菌71株,占26.8%,真菌12株,占4.5%,较常见的病原菌是大肠埃希菌、屎肠球菌、克雷伯菌属、粪肠球菌、铜绿假单胞菌等;革兰阴性菌对阿米卡星、亚胺培南和哌拉西林/他唑巴坦的耐药率较低,均<30.0%,革兰阳性菌对万古霉素耐药率最低,真菌的药物敏感性很好。结论胆道感染的病原菌种类有增加的趋势,但仍以革兰阴性菌为主,肠球菌属所占比率有所上升;在抗感染治疗中阿米卡星或哌拉西林/他唑巴坦和万古霉素首选,同时兼顾厌氧菌和真菌。

OBJECTIVE To investigate the distribution of pathogenic bacteria in biliary tract infection during 2005 to 2009 and analyze the change of their drug resistance.METHODS 391 bile specimens collected for the past five years were cultured,and the bacterial identification and drug sensitivity test were performed.RESULTS A total of 265 stains were isolated and the positive rate was 55.0% including 182 Gram-negative stains,71 Gram-positive stains and 12 fungal strains.The most common pathogenic bacteria were Escherichia coli,Enterococcus faecium,Klebsiella,Enterococcus faecalis,Enterobacter and Pseudomonas aeruginosa.The results of drug resistance showed that the resistant rates of Gram-negative strains to amikacin,imipenem and penicillin/tazobactam were lower than 30.0%.The resistant rate of Gram-positive strains to vancomycin was the lowest.The drug sensitivity of fungal strains was good.CONCLUSION The varieties of pathogenic bacteria in biliary tract infection are increasing,but Gram-negative strains remain the most common bacteria.The composition ratio of Enterococcus is rising.Amikacin or penicillin/tazobactam and vancomycin may be the ideal drugs for experiential therapy.