鲁西南地区胆管结石并胆系感染患者胆汁细菌学及药敏结果分析

Bacteriology of bile and drug sensitivity analysis in patients with bile duct stones and biliary tract infection in Southwest Shandong

目的探讨鲁西南地区胆管结石合并胆系感染患者胆汁细菌学及耐药性变化,为本地区胆管结石并胆系感染患者合理应用抗生素提供理论依据。方法对2008.12～2010.12入住我院的200例胆管结石并胆系感染患者术中抽取胆汁,行细菌培养及药敏试验。结果 200例患者胆汁标本中共分离细菌134株,阳性分离率为67%,仍以G-杆菌为主,前两位为大肠埃希菌(35.8%)、肺炎克雷伯菌(11.2%)。而G+球菌的肠球菌属主要为粪肠球菌(14.9%)和屎肠球菌(8.9%)。大肠埃希菌及肺炎克雷伯菌对亚胺培南、厄他培南、阿米卡星未出现耐药株,对其余9种抗生素均有不同程度耐药。肠球菌属对大多数常见抗生素耐药,对万古霉素、呋喃妥因、替考拉宁未出现耐药株。粪肠球菌对青霉素的耐药率也较高,达34.1%。结论鲁西南地区胆管结石并胆系感染患者胆汁培养细菌的菌种明显增加,菌群已经发生变迁,而且对临床应用广泛的抗生素耐药率明显增加。

Objective： To explore bile bacteriology and drug resistance of patients with bile duct stones with biliary tract infection in southwest in Southwest Shandong so as to apply clinic some suggestions for rational use of antibiotics.Methods： 200 cases’ bile of patients undergoing of bile duct stones and biliary tract infection admitted to our hospital between December 2008 and December 2010 were collected,bacterial culture and susceptibility testing were done.Germiculture and antibiotic susceptibility test were carried out.Results： Bacteria were found in 134 cases of 200 cases.The total positive rate was 67%,which was mainly G-bacilli,the first two were Escherichia coli（35.8%） and Klebsiella pneumoniae（11.2%）.Enterococcus faecalis（14.9%） and Enterococcus faecium（8.9%） were the main part of G＋ cocci Enterococcus.The resistant strains of Escherichia coli and Klebsiella pneumoniae to imipenem,ertapenem,and amikacin were not found.Escherichia coli and Klebsiella pneumoniae had different levels of resistance to the remaining nine antibiotics.Enterococcus resistants to most common antibiotics,the resistant strains of Vancomycin,nitrofurantoin,teicoplanin were not found.Enterococcus faecalis had high levels of resistance to penicillin（34.1%）.Conclusion： Bile culture bacteria strains of patients with bile duct stones and biliary tract infections in Southwest Shandong significantly increase,and the bacteria are changed,and the resistance rate to antibiotic which is widely used in clinics are significant increased.