舟山海岛地区胆汁培养病原菌分布及耐药性分析

Analysis of distribution and antibiotic resistance of pathogens from bile culture in Zhoushan island area

目的分析舟山地区5年来胆汁培养病原菌的分布和耐药性变迁。并对大肠埃希菌ESBLs阳性与ESBLs阴性耐药差异做对比。方法用ATB Expression半自动微生物分析仪进行菌株鉴定及药敏试验。结果 2568份胆汁培养标本共分离出病原菌738株,总阳性率为28.74%。其中革兰阳性菌177株,占总分离率的23.98%,革兰阴性菌521株,占总分离率的70.60%,真菌40株,占5.42%,以大肠埃希菌为主,大肠埃希菌产ESBL菌株检出率53.23%。药敏结果显示革兰阳性球菌对红霉素、链霉素耐药率较高,未发现对万古霉素的耐药株,革兰阴性杆菌对一、二代头孢耐药率较高,大肠埃希菌未发现亚胺培南和美罗培南的耐药株,对头孢他定、头孢吡肟的耐药率逐年明显上升,大肠埃希菌ESBLs阳性菌对环丙沙星、庆大霉素、哌拉西林/他唑巴坦、阿米卡星、复方新诺明等的耐药率都明显高于ESBLs阴性的耐药率,两者间差异有统计学意义(P<0.01)。结论舟山地区胆汁培养病原菌以大肠埃希菌为主,大肠埃希菌ESBLs阳性菌的耐药率大部分明显高于ESBLs阴性的耐药率,药敏结果提示对部分抗生素的耐药率逐年上升应加以重视。

Objective To investigate the distribution and antibiotic resistance of pathogens from bile culture in Zhoushan island area in last 5 years in Zhoushan city, and compare the drug resistance difference between E. coli ESBL positive strains and E. coli ESBL negative strains. Methods The pathogen identification and drug sensitivity to antibiotics were carried out by semi - automatic microbiological analyzer ATB - expression. Results A total of 738 pathogenic strains were isolated from 2568 bile - culture specimens and the positive rate was 28.74%. Among them, 177 strains were gram- positive bacteria（23.98% ）, 521 strains were gram -negative bacteria（70.60% ）, and 40 strains were fungi（5.42% ）, with E. coli being the most frequent iso- lates, and the ESBLs -positive rate of Escherichia coli strains reached 53.23%. The drug sensitivity test results showed that Gram - positive cocci was highly resistant to erythromyein and streptomycin, and no vancomycin - resistant srtain was found. While Gram - negative bacilli was highly resistant to the first - and second - generation cephlosporins. E. coli were not found resistant to imipenem and meropenem, but showed increasing drug resistance to ceftazidime and eefepime. The antibiotic resist- ance of E. coli ESBL - positive strains to ciprofioxaein, gentamicin, piperaeillin/tazobactam, amikacin and cotrimoxazole were higher than E. coli ESBL - negative strains, and there was significant statistical difference between the two groups （ P 〈 0.01 ）. Conclusion Escherichia coli is the main pathogen from bile culture in Zhoushan city. The antibiotic resistance of E. coli ESBL - positive strains were higher than that of E. coli ESBL - negative strains. More attention should be paid to the increasing re- sistance rates of E. coli to some antibiotics.