胆道手术患者细菌感染及抗菌药物敏感性分析

Analysis of pathogen infection and antibiotics sensitivity in patients undergoing biliary surgery

目的探讨胆道感染致病菌的分布特点及药敏情况,为临床合理使用抗生素提供依据。方法 464例胆道手术患者于手术中抽取胆汁行细菌培养与药敏试验,分析其实验结果。结果 464例患者中,胆汁培养阳性114例,共培养出细菌123株,其中革兰氏阴性菌91株(74.0%),革兰氏阳性菌32株(26.0%),主要致病菌为大肠埃希菌、肠球菌、肺炎克雷伯杆菌、阴沟杆菌、铜绿假单胞菌。碳青霉烯类抗菌药物对革兰氏阴性菌敏感性较好,万古霉素对革兰氏阳性菌敏感性较好。结论胆汁培养阳性率与胆道疾病严重程度存在密切的联系。治疗胆道感染首选对大肠埃希菌耐药率低的广谱抗菌药物,必要时可加用抗革兰氏阳性菌药物。

Objective To explore the clinical distribution and drug sensitivity of pathogen isolated from bili- ary tract infection of surgery, and to guide the rational use of antibiotics. Methods The clinical data of 464 patients, whose bile samples were obtained in surgery to perform the bacteria culture and drug susceptibility test, were retro- spectively analyzed. Results Of the 464 patients, 114 were found with positive bile culture. A total of 123 strains of bacteria were isolated, including 91 strains of gram negative （74.0%） and 32 strains of gram positive bacteria （26.0%）. The most common bacteria were E. coli, Enterococcus, Klebsiella pneumonia, Bacillus cloacae, Pseudomonas aeruginosa. Susceptibility test demonstrated that gram negative bacteria were sensitive to Carbopenems and gram positive bacteria were sensitive vancomycin. Conclusion Positive bile culture was closely related to biliary diseases. Broad spectrum antibiotics which was more effective to E. coli is recommended as the first choice for bile infection. If necessary, the combination use of antibiotics for gram positive bacteria was recommended.