胆道感染的病原学和细菌耐药性的分析

ANALYSIS OF THE CHANGES OF BILIARY BACTERIA AND THEIR RESISTANCE TO ANTIBIOTIC

目的了解胆汁培养的病原菌分布及变迁以及耐药性的变化,为指导临床用药提供依据。方法对2005年10月~2 010年10月问收治的278例胆道感染患者的胆汁细菌培养阳性的188株病原菌分布及耐药情况作回顾性分析。结果对于2005年10月~2008年10月、2008年10月~2010年10月两个时间段126、152份胆汁标本中各有65、102份病原菌培养阳性,分别检出病原菌70、118株;所分离的病原菌以革兰阴性杆菌为主,2个时间段分别占71.4%、65.3%,革兰阳性菌分别为28.6%、29.6%,大肠埃希菌仍占最大比例,2个时间段分别为37.10%、31.4%,大肠埃希菌中ESBLs阳性耐药株分别为分别为15.4%,45.9%（P=0.011）,ERCP引起胆道感染的病原菌发生明显的变迁（P=0.002）。结论胆道感染的病原菌中主要以大肠埃希菌、肠球菌属等为主,大肠埃希菌中ESBLs阳性耐药株明显升高。

Objective To study the changes of biliary bacteria and their resistance to antibiotics in bile samples of patients with biliary tract infection.Methods The data of 188 strains of microbes were found in 278 patients with positive bile culture from Oct 2005 to Oct 2010 and their resistance to antibiotics were analyzed retrospectively.Results There were 65 and 102 positive samples respectively in 126 samples during the first half of this study（2005~2008） and 152 ones during the second half（2005~2010）as well as 70 and 118 strains cultured.Gram-negative bacteria accounted for 71.4% and 65.8% and Gram-positive accounted for 28.6% and 29.6.%.Esc herichia coli was the major one and accounted for 37.1% and 31.4%.The rates of positive ESBLs bacteria was increasing（15.4% vs 45.9%,P=0.011）.The factor that influnced the changes of pathogens was ERCP.（P=0.002）.Conclusion The main pathogens of biliary infection are E.coli and Enterococcus.The rates of positive ESBLs bacteria was increasing.The factor that influnced the changes of pathogens was ERCP.It is important to use antibiotics properly to control the infection of biliary tract.