胆石症患者胆道感染的病原学分析与治疗探讨

Etiological analysis and treatment of biliary tract infections suffered by cholelithiasis patients

目的探讨胆石症胆道感染的病原学现状,并予以相应的措施进行诊治,以期提高临床治疗水平。方法回顾性分析2010年1月-2013年1月370例胆石症患者的临床资料,对其中胆道感染患者病原菌分布及耐药性进行分析;采用PPMS软件进行统计分析,计量资料采用t检验,计数资料采用χ2检验。结果 370例胆石症患者中发生胆道感染79例,感染率为21.35%;共检出病原菌79株,其中革兰阳性菌32株占40.51%,前3位菌依次为粪肠球菌、酿脓链球菌、金黄色葡萄球菌,分别占13.92%、11.39%、11.39%,革兰阴性菌47株,占59.49%,前3位菌依次为大肠埃希菌、克雷伯菌属、铜绿假单胞菌,分别占18.99%、16.46%、11.39%;主要革兰阴性菌对美罗培南、亚胺培南、头孢曲松的耐药率均在0~11.11%,另外大肠埃希菌、铜绿假单胞菌对头孢噻肟的耐药率分别为13.33%、22.22%,克雷伯菌属对左氧氟沙星的耐药率为15.38%;主要革兰阳性菌对万古霉素、替考拉宁、头孢米诺的耐药率较低,均在0～11.11%,且粪肠球菌、金黄色葡萄球菌对头孢噻肟的耐药率分别为18.18%、11.11%,酿脓链球菌对氨苄西林/舒巴坦的耐药率为11.11%。结论胆石症并胆道感染病原菌以为革兰阴性菌为主,临床上要加强监管和治疗。

OBJECTIVE To investigate the etiological status of biliary tract infections among cholelithiasis patients and offer corresponding measures for treatment so as to improve the level of clinical treatment.METHODS The clinical data of 370cases of cholelithiasis patients from Jan 2010to Jan 2013were retrospectively analyzed,and the pathogen distribution and drug resistance were analyzed among those patients who suffered from biliary tract infections;PPMS software was adopted for statistical analysis,t-test was adopted for testing measurement data and Chi-square was adopted for testing enumeration data.RESULTS Totally,79cases of the 370cases of cholelithiasis patients suffered from biliary tract infections,with the infection rate of 21.35%;a total of 79strains of pathogens were detected,gram-positive bacteria were 32strains（40.51%）with the top 3pathogens of Enterococcus faecalis,Streptococcus pyogenes and Staphylococcus aureus,accounting for 13.92%,11.39%and 11.39%respectively;gram-negative strains were 47strains（59.49%）,with the top 3pathogens of Escherichia coli,Klebsiellaand Pseudomonas aeruginoosa,accounting for 18.99%,16.46% and 11.39% respectively;all the drug resistance rates of dominant gram-negative bacteria to meropenem,imipenem and ceftriaxone were between 0-11.11%,besies,the resistance rates of E.coli,and P.aeruginosato cefotaxime were 13.33%and 22.22%respectively,and the drug resistance rate of Klebsiellato levofloxacin was 15.38%;the dominant gram-positive bacteria had low drug resistance rate between 0and 11.11%to vancomycin,teicoplanin and cefminox,the drug resistance rates of E.faecalis and Staphylococcus aureus to cefotaxime were 18.18%and 11.11%respectively,and the drug resistance rates of S.pyogenes to ampicillin-sulbactam was 11.11%.CONCLUSIONGram-negative bacteria are the dominant pathogens causing biliary tract infection to cholelithiasis patients,and it is necessary to strengthen monitoring and treatment in clinical practice.