急性轻症胆源性胰腺炎患者胆汁病原菌的分布及耐药性

Microbial profile and antibiotic sensitivity pattern in bile cultures from patients with acute mild biliary pancreatitis

目的:分析急性轻症胆源性胰腺炎患者胆汁病原菌的菌群分布、临床常用抗菌药物的敏感性及有关因素,为急性胆源性胰腺炎患者抗菌药物的合理应用提供参考.方法:2002-01/2012-02,96例行逆行胰胆管造影术(endoscopic retrograde cholangiopancreato graphy,ERCP)或手术治疗的急性轻症胆源性胰腺炎患者,取胆汁进行细菌学培养和抗菌药物敏感性检测.结果:96例急性轻症胆源性胰腺炎患者中69例胆汁培养阳性,阳性率为71.9%;主要病原菌为肠球菌属和大肠埃希菌属,检出率分别为27.0%和19.2%,其次为肺炎克雷伯杆菌(占11.5%)、铜绿假单胞菌(占10.3%),真菌检出率为3.8%.其中,革兰阳性球菌对替考拉宁、万古霉素的敏感率均为100%;革兰阴性杆菌对阿米卡星、亚胺培南较为敏感,敏感率分别为85.7%、81.0%;对哌拉西林/他唑巴坦敏感率为57.1%;对头孢他定、头孢吡肟和左氧氟沙星的敏感较低.革兰阴性杆菌的超广谱β-内酰胺酶(extended spectrum B-lactamase,ESBLs)的阳性率为66.7%.结论:急性轻症胆源性胰腺炎患者的胆道感染以肠球菌属占首位,对急性轻症胆源性胰腺炎合并胆道感染的治疗,应尽早解除胆道梗阻,并根据药物敏感性选择合适的抗生素,尤其要注意考虑到覆盖肠球菌属.

AIM： To study the profile of pathogen strains from bile of patients with acute mild biliary pancreatitis and their resistance to antimicrobial agents.METHODS： Bile samples from 96 patients with acute mild biliary pancreatitis were cultured and tested for antibiotic susceptibility.RESULTS： The most common organism was enterococci （27%）, followed by Escherichia coli （19.2%）, Pseudomonas aeruginosa （11.5%）, and Klebsiella pneumoniae （10.3%）. None of Gram- positive strains were resistant to telicoplanin andvancomycin. The percentage of Gram-negative strains that were sensitive to amikacin was high- est （85.7%）, followed by imipenem （81%）, piper- acillin and tazobactam （57.1%）, cefepime hydro- chloride （28.6%）, and levofloxacin （19.0%）. The percentage of ESBLs-producing bacteria in Gram- negative strains was 66.7%.CONCLUSION： Enterococci have been found more commonly in patients with acute mild bili- ary pancreatitis. Combined antibiotic treatment with biliary decompression as early as possible is suggested for biliary obstructive infection. After biliary decompression, antibiotics will be selected according to the results of susceptibility test.