胰腺癌伴梗阻性黄疸患者胆道感染的病原菌分析

Distribution of pathogens causing biliary tract infections in pancreatic cancer patients complicated with obstructive jaundice

目的探讨胰腺癌伴梗阻性黄疸患者胆道感染的病原菌分布及耐药性,以指导临床合理应用抗菌药物。方法选取2010年1月-2013年1月在医院治疗的47例胰腺癌伴梗阻性黄疸胆道感染患者为研究对象,对其常见的病原菌进行分析,并运用相关的检测手段分析病原菌的耐药性。结果共检出病原菌65株,其中革兰阴性菌49株占75.4%,革兰阳性菌14株占21.5%,真菌2株占3.1%,排名前5位病原菌依次为大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、铜绿假单胞菌、肠球菌属,分别占23.1%、16.9%、13.8%、10.8%、10.8%;革兰阴性菌除对美罗培南、亚胺培南、头孢曲松较敏感外,对常用抗菌药物均产生了较严重的耐药性;革兰阳性菌对青霉素、头孢菌素类和氨基糖苷类等耐药性明显,仅对替考拉宁、亚胺培南、万古霉素100.0%敏感。结论胰腺癌伴梗阻性黄疸患者胆道感染以革兰阴性菌为主,临床上应用药物要以美罗培南、亚胺培南、头孢曲松、替考拉宁、万古霉素等敏感性较好的药物为主。

OBJECTIVE To explore the distribution and drug resistance of pathogens causing biliary tract infections in the pancreatic cancer patients complicated with obstructive jaundice so as to guide the reasonable use of antibiotics. METHODS Totally 74 cases of pancreatic cancer patients complicated with obstructive jaundice, who were treated in the hospital from Jan 2010 to Jan 2013, were enrolled in the study, then the distribution of the common pathogens was analyzed, and the drug resistance was observed with use of related detection methods. RESULTS A total of 65 strains of pathogens were isolated, including 49 （75. 4%） strains of gram-negative bacteria, 14 （21.5 %） strains of gram-positive bacteria, and 2 （3.1%） strains of fungi. Escherichia coli, Klebsiella pneurnoniae, Enterobacter cloacae, Pseudomonas aeruginosa , and Enterococci ranked the top five species, accounting for 23.1%, 16.9%, 13.8%, 10.8%, and 10.8%, respectively. The gram-negative bacteria were highly resistant to all the commonly used antibiotics except for meropenem, imipenem, and ceftriaxone; the gram-positive bacteria were significantly resistant to penicillin, cephalosporins, or aminoglycosides, with the 100.0% of drug susceptibility rate to teicoplanin, imipenem, or vancomyein. CONCLUSION The gram-negative bacteria are the predominant pathogens causing biliary tract infections in the pancreatic cancer patients complicated with obstructive jaundice, and the susceptible antibiotics such as meropenem,imipenem, ceftriaxone, teicoplanin, and vancomycin are most commonly used.