小儿先天性胆总管囊肿胆汁细菌培养及药敏分析

Bacterial culture of bile in children with congenital choledochal cyst and drug sensitivity test

目的通过对先天性胆总管囊肿术中胆汁的细菌培养及药物敏感试验,为围手术期及术后合理应用抗菌药物提供依据。方法选择医院1995年1月-2010年10月收治的小儿先天性胆总管囊肿手术患儿,术中用无菌注射器抽取胆汁标本,进行细菌培养及药物敏感试验。结果 156份胆汁标本中42份胆汁标本检出细菌,检出率为26.9%,共检出细菌49株,其中革兰阴性菌38株,占77.6%,革兰阳性菌11株,占22.4%,检出主要细菌分别为大肠埃希菌、粪肠球菌、克雷伯菌属,分别占49.0%、14.2%、10.2%;对先天性胆总管囊肿细菌敏感的药物有亚胺培南、万古霉素、阿米卡星和第三代头孢菌素类。结论小儿先天性胆总管囊肿细菌感染率不高,但对临床常用抗菌药物有较明显的耐药性,术中胆汁细菌培养及药物敏感试验对抗菌药物的选择具有指导作用。

OBJECTIVE To provide a reasonable basis for the proper application of antibiotics in perioperative and postoperative period by analyzing bacterial culture and drug sensitivity test of bile in children with congenital choledochal cyst.METHODS From Jan 1995 to Oct 2010,the children with congenital choledochal cyst who underwent Roux-en-Y choledochojejunostomy were enrolled in the study,bile samples were collected for the bacterial culture and drug sensitivity test.RESULTS Pathogens were detected in 42 bile samples,the bacteria positive rate was 26.9%,including 38 strains of Gram-negative bacteria（77.6%） and 11 strains of Gram-positive bacteria（22.4%）.The common pathogens were Escherichia coli,Enterococcus faecalis,Klebsiella pneumoniae and Pseudomonas aeruginosa,accounting for 49.0%,14.2% and 10.2% respectively.The antibiotics sensitivee to bacteria were imipenem,vancomycin,amikacin and third generation cephalosporins.CONCLUSION The bacterial infection rate of congenital choledochal cyst in children is not high,but these pathogens are significantly resistant to commonly used antibiotics.Bacterial culture of bile during the surgery and drug sensitivity test may offer guidance of antibiotic selection for the children with congenital choledochal cyst.