胆道感染患者胆汁细菌分布及药敏结果分析

Bile Bacteria Distribution and Drug Susceptibility in Patients with Biliary Infections

目的分析胆道感染患者胆汁中病原菌的分布及抗菌药物的耐药性,指导临床合理选择抗菌药物。方法对贵港市人民医院142份胆汁标本进行细菌培养及药敏试验,并统计分析。结果检出病原菌73株,阳性率为51.4%,病原菌主要为大肠埃希菌(49.3%)、铜绿假单胞菌(17.8%)、肺炎克雷伯菌(9.6%)和肠球菌属(13.7%);大肠埃希菌和肺炎克雷伯菌产ESBLs的阳性率分别是36.1%和28.6%;主要革兰阴性杆菌对亚胺培南耐药率为0,其次是阿米卡星、哌拉西林/他唑巴坦(<30%),而对氨苄西林耐药率最高,对其他常用抗菌药物耐药率程度也较高。肠球菌属对万古霉素、亚胺培南和替考拉宁耐药率最低,其次为左氧氟沙星、庆大霉素、环丙沙星和氨苄西林。其他抗菌药物耐药率在60%以上。结论胆汁中病原菌种以大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌和肠球菌多见,产ESBLs的菌株的耐药率明显高于非产ESBLs的菌株;肠球菌耐药率较低。临床应依据药敏结果合理应用抗菌药物。

Objective To investigate the distribution and bile antimicrobial resistance of pathogenic bacteria in patients with biliary infections,and to guide clinical rational antimicrobial choice.Methods Bile bacterial culture and drug sensitive test were conducted in 142 specimens,and statistical analysis was performed.Results 73 strains of pathogenic bacteria were detected,with the positive rate 51.4%.The pathogens wer as follows： escherichia coli（49.3%）,pseudomonas eruginosa（17.8%）,pneumoniae Klebsiella bacteria（9.6%） and enterococcus（13.7%）;positive rate of ESBLs producing Escherichia coli and pneumoniae Klebsiella were 36.1% and 28.6%,respectively;resistant rate of main gram-negative bacteria to imipenem was 0,followed by Amikacin,Piperacillin/tazobactam（30%）,which was the most resistant to ampicillin,with high antimicrobial resistance to other common antibiotics.Enterococcus showed low resistant to vancomycin,imipenem and Teicoplanin,followed by levofloxacin,gentamycin,levofloxacin and ampicillin.Antimicrobial resistance was more than 60% to other antibiotics.Conclusion In the bile,pathogenic escherichia coli,pseudomonas aeruginosa,and pneumonia Klebsiella bacteria and enterococcus were more frequent,ESBLs resistant strains were significantly higher than the non-ESBLs strains;Enterococcus resistance was low.Clinical reasonable application of antimicrobial drugs should be based on the drug sensitive results.