经皮肝穿胆道引流术后胆汁病原菌分布及耐药性

Bacterial culture of bile after percutaneous transhepatic biliary drainage and analysis of drug resistance

目的探讨梗阻性黄疸患者经皮肝穿胆道引流术(PTBD)后胆汁病原菌培养结果及耐药性,为临床合理使用抗菌药物提供参考。方法回顾性分析2011年8月-2012年7月71例梗阻性黄疸患者PTBD术后胆汁细菌培养及药敏试验结果。结果 71例胆汁培养共检出49株病原菌,其中革兰阴性菌40株占81.6%,革兰阳性菌7株占14.3%,真菌2株占4.1%,排名前5位病原菌依次为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、嗜麦芽寡养单胞菌、弗氏柠檬酸杆菌,分别占22.4%、12.2%、8.2%、8.2%、6.1%;病原菌对常用抗菌药物均产生了不同程度的耐药性,革兰阴性菌对碳青霉烯类及阿米卡星耐药最低,其次为头孢三代/β-内酰胺酶抑制剂。结论梗阻性黄疸患者胆汁培养主要是革兰阴性菌,且耐药性严重,临床应该重视病原学监测,按照药敏试验结果合理用药,在培养结果报告以前,如果患者有感染症状,推荐使用头孢三代/β-内酰胺酶抑制剂作为经验性用药。

OBJECTIVE To study the bacterial culture of bile of the obstructive jaundice patients after percutaneous transhepatic biliary drainage （PTBD） so as to provide a reference for the rational use of antibiotics. METHODS The result of the bile culture for 71 obstructive jaundice patients who underwent PTBD from Aug 2011 to Jui 2012 was respectively analyzed, and the drug susceptibility testing was performed. RESULTS Totally 49 strains of pathogens were isolated from the bile specimens obtained from 71 patients, including 40 strains of gram-negative bacteria （81.6%）, 7 strains of gram-positive bacteria （14.3%）, and 2 strains of fungi （4.1%）; the Escherichia coli （22.4%）, K lebsiella pneumoniae （12.2%）, Pseudomonas aeruginosa （8.20%）, Stenotrophomonas maltophilia （8.2 % ） ,and Citrobacter freundii （6.1 %） ranked top five species of pathogens. The pathogens varied in the drug resistance to the commonly used antibiotics; the drug resistance rates of the gram-negative bacteria to carbapenems and amikacin were the lowest, followed by the drug resistance rate to the third generation cephalosporin/β-lactamase inhibitor. CONCLUSION The gram-negative bacteria are the predominant pathogens cultured from the bile of obstructive jaundice patients and are highly drug resistant; it is necessary for the hospital to focus on the etiological monitoring and use antibiotics based on the result of drug susceptibility testing; the third generation cephalosporin/β-lactamase inhibitors are recommended for use as empirical drugs for the patients with infections before the bacterial culture result comes out.