胆道感染的病原菌特征及耐药性分析

Characteristics and drug resistance of pathogens causing biliary tract infections

目的探讨胆道感染的病原菌特征及耐药性,指导临床合理用药。方法回顾性分析257例胆道感染患者的临床资料,对胆汁标本进行常规培养、分离和鉴定,采用K-B纸片法进行药敏试验。结果 257份胆汁标本,培养阳性结果180份,阳性率为70.04%;共检出184株病原菌,革兰阴性菌112株60.87%,革兰阳性菌68株36.96%,真菌4株2.17%,检出最多的4种细菌为大肠埃希菌、粪肠球菌、肺炎克雷伯菌、屎肠球菌,分别占27.17%、20.65%、11.96%,10.87%;大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、粪肠球菌和屎肠球菌对常用抗菌药物均呈现出不同程度的耐药性,革兰阴性菌对头孢哌酮/舒巴坦的耐药率较低,对亚胺培南无耐药,革兰阳性菌对万古霉素、利奈唑胺和替拷拉宁无耐药性。结论大肠埃希菌和肠球菌属是胆道感染的常见病原菌,并且其耐药性复杂,临床用药务必根据药敏试验选择合理的抗菌药物。

OBJECTIVE To explore the features and drug resistance of the pathogens causing biliary tract infections and to guide the rational drug use. METHODS The clinical data of 257 cases of patients with biliary tract infections were reviewed retrospectively. The culture, isolation, and identification of biliary samples were performed in regular routine. The drug susceptibility testing was performed by K-B disc diffusion method. RESULTS The positive culture rate was 70. 04% （180/257）. A total of 184 strains of pathogens were isolated, includingll2 （60.87%） strains of gram-negative bacteria, 68 （ 36. 96%） strains of gram-positive bacteria, and 41 （2. 17%） strains of fungi. The top 4 species of pathogens isolated were Escherichia coli （27. 17%）, Enterococcus faecalis （20.65%）,Klebsiella pneumoniae （11. 96%）, and Enterococcus faecium （10. 87%）, which varied in the drug resistance to the commonly used antibiotics. The drug resistance rates of the gram-negative bacteria to cefoperazone/sulbactam were relatively low, the drug resistance rate to imipenem was 0%. The gram-positive bacteria showed no drug resistance to vancomycin,linezolid, and teicoplanin. CONCLUSION E. coli and Enterococci are the common species of pathogens causing biliary tract infections, their drug resistance is complex, the hospital should reasonably select the antibiotics based on the drug susceptibility testing.