胆石症患者胆道感染的病原菌药敏分析

Distribution and drug susceptibility of pathogens causing biliary tract infections in patients with cholelithiasis

目的分析胆石症患者胆道感染的病原菌分布及其药敏分析,进一步指导临床用药,有效控制胆道感染。方法收集2008-2012年胆石症并胆道感染患者胆汁进行培养,对分离出的2 154株病原菌进行鉴定和药物敏感试验;数据采用SPSS 17.0软件进行统计分析。结果 2 154株胆道感染病原菌中革兰阴性菌占56.3%,革兰阳性菌占41.7%,真菌占2.0%,常见的病原菌是肠球菌属、大肠埃希菌、克雷伯菌属、铜绿假单胞菌等;5年克雷伯菌属及真菌所占的比率上升(P<0.05),而肠球菌属所占的比率未再出现上升趋势;病原菌对抗菌药物的敏感率均有逐渐下降趋势;革兰阴性菌对哌拉西林/他唑巴坦、碳青酶烯类、氨基糖苷类抗菌药物敏感率分别为86.3%、90.8%、94.5%;革兰阳性菌对呋喃妥因、万古霉素、替考拉宁、利奈唑胺敏感率分别为93.3%、95.8%、97.5%、98.2%,但对利奈唑胺敏感率逐渐下降趋势;真菌的药物敏感性很好。结论 5年胆道感染菌群变迁,临床应用的抗菌药物敏感率下降;动态监测菌群和药物敏感性的变化,正确合理使用抗菌药物以有效控制胆道感染。

OBJECTIVE To analyze the distribution and drug susceptibility of the pathogens causing biliary tract infections in patients with cholelithiasis so as to guide the clinical use of antibiotics and effectively control the biliary tract infections.METHODS From 2008through 2012,the bile specimens were collected from the cholelithiasis patients complicated with biliary tract infections,then the identification of 2 154strains of pathogens and the drug susceptibility testing were carried out,and the data were statistically analyzed with the use of SPSS 17.0software.RESULTS Among the 2 154strains of pathogens causing biliary tract infections,the gram-negative bacteria accounted for 56.3%,the gram-positive bacteria 41.7%,the fungi 2.0%;the Enterococci,Escherichia coli,Klebsiellaspp,and Pseudomonas aeruginosa were the most common pathogens.In the five years,the constituent ratios of the Klebsiellaspp and fungi showed an upward trend（P〈0.05）,while the constituent ratio of the Enterococci did not show an upward trend.The drug susceptibility rates of the pathogens showed a downward trend,the drug susceptibility rates of the gram-negative bacteria to piperacillin/tazobactam,carbapenems,and aminoglycosides were 86.3%,90.8%,and 94.5%,respectively;the drug susceptibility rates of the gram-positive bacteria to nitrofurantoin,vancomycin,teicoplanin,and linezolid were 93.3%,95.8%,97.5%,and 98.2%,respectively,however,the drug susceptibility rate to linezolid showed a downward trend;the fungi were highly susceptible to drugs.CONCLUSIONS The pathogenic flora causing the biliary tract infections change in the five years,and the drug susceptibility rates to the clinically used antibiotics are decreased.It is an effective way to dynamically monitor the change of pathogenic flora as well as the drug susceptibility and reasonably use antibiotics so as to control the biliary tract infections.