胆道感染病原菌及其对抗菌药物敏感性变化的研究

Pathogenic bacteria causing biliary infection and changes of drug sensitivity to antibiotics

目的了解胆道感染时胆汁中病原菌及其对抗菌药物敏感性的变化,为临床选择用药提供参考和依据。方法将2006年1月-2009年12月培养阳性的264份胆汁标本中,323株病原菌及药敏结果进行统计分析。结果 323株病原菌中包含了52种细菌,其中革兰阴性杆菌59.4%,革兰阳性球菌占40.6%;列前6位的细菌依次为:肠球菌属22.0%,大肠埃希菌19.5%,克雷伯菌属11.8%,葡萄球菌属10.9%,假单胞菌属8.7%,肠杆菌科8.4%;59例混合感染中,大肠埃希菌和铜绿假单胞菌各占12例和10例;细菌对青霉素类、头孢类、喹诺酮类、大环内酯类抗菌药物敏感性普遍下降,对亚胺培南、美罗培南、万古霉素,替考拉宁仍保持相当高的敏感率;阿米卡星对细菌敏感性也较高,尤其对铜绿假单胞菌有效率仍达68.7%。结论胆道感染病原菌不断在改变,细菌数量和种类在增加,其对药物敏感性普遍下降;治疗胆道感染应动态监测菌群和药物敏感性的变化及合理应用抗菌药物。

OBJECTIVE To study the changes of biliary bacteria and their sensitivity to antibiotics. METHODS The data of 323 strains of aerobes found in 264 patients with positive bile culture from Jan 2006 to Dec 2009 and their sensitivity to antibiotics were statistically analyzed. RESULTS The 323 strains of aerobes belonged to 52 species： Gram negative bacteria accounted for 59. 4% and Gram positive cocci accounted for 40. 6%. The leading six bacteria detected were Enterococcus （ 22. 0 % ）, Eseherichia （ 19. 5 %）, Klebsiella （ 11. 8%）, Staphylococcus （10.9%）, Pseudomonas aeruginosa （8. 7%） and Enterobacter （8. 4%）. Among 59 cases of mixed infection, 12cases and 10 cases were infected with Escherichia and P. aeruginosa respectively. The bacteria were highly resistant to penicillin, cephalosporins and quinolones. However, they were highly sensitive to imipenem, rneropenem, vancomycin and teicoplanin. The bacteria kept high sensitivity to amikacin. Especially 68.7% of P. aeruginosa were sensitive to it. CONCLUSION Types of pathogens of biliary tract infection as well as their antibiotic resistance are increasing, so it is important to keep on detecting the changes of biliary bacteria and their sensitivity to antibiotics and proper use of antibiotics.