胆道感染患者胆汁培养病原菌分布及耐药性分析

Distribution of pathogenic bacteria cultivating by bile from patients with biliary tract infections and drug resistance analysis

目的了解中医院胆道感染患者胆汁培养病原菌种类及耐药性,为临床医师选择抗菌药物治疗提供参考依据。方法胆汁标本的留取、培养和细菌种类鉴定按照《全国临床检验操作规程》进行操作;抗菌药物敏感监测按WHO和CLSI指定的纸片扩散法(K-B法)进行操作,试验全过程进行分析前、中、后质量控制。结果 205份患者送检胆汁标本中细菌培养阳性107份,阳性率为52.2%;107株病原菌中革兰阴性杆菌70株占65.4%,革兰阳性球菌28株占26.2%,真菌9株占8.4%,其中大肠埃希菌检出最多46株占43.0%,其次为粪肠球菌14株占13.1%;大肠埃希菌和肺炎克雷伯菌对碳青霉烯类亚胺培南和美罗培南、粪肠球菌对糖肽类万古霉素和替考拉宁100.0%敏感;59株大肠埃希菌和肺炎克雷伯菌中分离到产超广谱β-内酰胺酶24株,阳性率为40.7%。结论胆汁培养分离的细菌耐药性日趋严重,医院应继续认真执行卫生部《抗菌药物临床应用管理办法》,推行合理用药,强化、细化抗菌药物处方管理,改变细菌耐药性快速增长的不良局面。

OBJECTIVE To investigate the species of pathogenic bacteria cultivating by bile from patients with biliary tract infections and drug resistance in traditional chinese hospitals, so as to provide the evidence for clinical use of antibiotics. METHODS Referring to National Guide to Clinical Laboratory Operation Procedures, bile collection, cultivation and bacterial identification were performed by the routine methods. The susceptibility testing was performed by disk diffusion methods recommended by WHO and CLSI. Quality control was performed during the total testing. RESULTS Of 205 samples,107 were positive. Positive isolating rate was 52.2%. Of 107 strains, 70 strains were gram-negative bacilli, accoqlnting for 65.4%, 28 gram-positive cocci for 26.2% and 9 fungi for 8.4%. The top one was Escflerichia coli 46 strains, accounting for 43.0%, followed by 14 strains of E. coli, accounting for 13. 1%. Susceptibility testing results indicated that E. coli and Klebsiella pneumonia had 100% sensitivity to imipenem and meropenem. Enterococcus faecalis had 100% sensitivity to vancomycin and teicoplanin. Of 59 isolates of E. coli and K. pneumonia, 24 strains （40. 7%） were ESBLs producers. CONCLUSIONS The antimicrobial resistance of pathogens causing infection of biliary tract was increasingly serious. Hospital should implement strictly Clinical Application Management of Antibiotics, keep using drugs properly, strengthen and refine the management of antimicrobial prescription to change the bad situation of increasing tendency of bacterial resistance.