ERCP治疗急性胆源性胰腺炎86例胆汁细菌培养及药敏分析

Analysis on bile bacteria and drug sensitivity of 86 cases of acute biliary pancreatitis treated with ERCP

目的了解急性胆源性胰腺炎(ABP)患者胆汁中主要致病菌的分布及其耐药情况,为临床治疗提供理论依据和治疗指导。方法选取2008年6月至2013年2月平顶山市第一人民医院消化内科收治的经内镜逆行胰胆管造影(Endoscopic Retrograde Cholangio-Pancreatography,ERCP)治疗的ABP患者86例,对术中抽取的胆汁标本行细菌培养和药敏试验,回顾性分析其临床结果。结果 86例送检标本中,共检出76株病原菌,检出率为88.4%,胆汁感染的革兰阴性菌以大肠埃希菌为最多,革兰阳性菌以粪肠球菌最多;厌氧菌以感染脆弱类杆菌、产气荚膜梭菌等为主。结论 ABP胆汁感染检出率高,致病菌种类与肠道细菌的种类基本一致,在胆汁细菌培养和药敏结果明确之前应尽量选用广谱的抗生素联合、足量用药;如药敏结果明确,则可根据治疗效果或药敏结果调整抗生素继续治疗,以提高疗效,避免浪费。

Objective To investigate the distribution and drug resistance of main pathogens in the biles of patients with acute biliary panereatitis （ABP）, and provide theoretical basis and guidance for clinical treatment. Methods A total of 86 cases of ABP treated with Endoscopic Retrograde Cholangio-Pancreatography （ERCP） from June 2008 to Feb. 2005 in our hospital were enrolled. The bile specimens were collected for bacterial culture and drug sensi- tive test, and the clinical results were retrospectively analyzed. Results In the 86 specimens, 76 strains of patho- genic bacteria were detected （ 88.4% ）. Escherichia coli was the main gram negative bacteria in the bile, while En- terococcus faecalis was the main gram positive bacteria. In the anaerobic bacteria, Bacteroides fragilis and Clostridi- um perfringens were predominant pathogens. Conclusion The bile infection rate in ABP patients is high. The spe- cies of pathogenic bacteria are similar to those in the intestine. Broad spectrum antibiotics may be used in combina- tion with adequate dose before learning the drug sensitivity results and then make the appropriate adjustments after the results are leanred.