急性胆囊炎腹腔镜胆囊切除术术中胆汁细菌培养及药物敏感试验分析

Biliary Bacterial Culture and Drug Sensitivity Test in Patients with Acute Cholecystitis Undergoing Laparoscopic Cholecystectomy

目的:探讨急性胆囊炎腹腔镜胆囊切除术患者胆道细菌培养与药敏特点,为临床合理应用抗生素提供依据。方法:对2008年1月～2011年8月间230例急性胆囊炎腹腔镜切除术(LC)患者胆汁标本进行培养、鉴定、药敏试验(DST)和分析。结果:230例中160例胆汁标本培养阳性,共分离菌株180株,其中革兰阴性杆菌占65.6%,革兰阳性球菌占28.9%,革兰阳性杆菌占5.6%;革兰阴性杆菌以大肠埃希菌为主,占64.4%,革兰阳性球菌以粪肠球菌为主,占42.3%;药敏结果显示:革兰阴性杆菌对亚胺培南,头孢曲松敏感率较高;革兰阳性球菌对万古霉素、亚胺培南敏感;大肠埃希菌对青霉素类,一、二代头孢类、妥布霉素等呈一定的耐药性。结论:急性胆囊炎LC术中应重视胆道细菌培养与药敏,并据药敏感结果等选择抗生素治疗。

Objective：To explore biliary bacterial culture and drug sensitivity test in patients with acute cholecystitis undergoing laparoscopic cholecystectomy.,to provide basis for clinical anti-infective therapy.Methods：Biliary samples of 230 patients with Acute Cholecystitis Undergoing Laparoscopic Cholecystectomy（LC）in our hospital from 2008.1 to 2011.8 were sujected to culture of biliary bacteria,identify and drug sensitivity test（DST）.Results：Of the total 230 bile specimens,160 were postive in bacteria culture,A total of 180 strains were isolated,With Gram-negative bacill,Gram-positive cocci and bacill representing 65.6%,28.9% and 5.6% respectively.Of the Gram-negative bacill,Gram-positive cocci,Escherichia coli,and Enterococcus faecalis representing 64.4% and 42.3% respectively.In the drug sensitivity,Gram-negative bacill were the most sensitive bacteria to Imipenem and Ceftriaxone,while Gram-positive cocci were the most sensitive bacteria to Vancomycin and Imipenem.Escherichia coli showed different degree of resistance to Penicillins,the one or two generation Cephalosporins and Tobramycin.Conclusion：Use of bile is necessary in bacterial culture and DST.Clinical antibiotics choice should be made reasonably based on results of laboratory DST,to prevent the abuse of antibiotics to reduce bacterial resistance.