内镜逆行胰胆管造影术后胆道感染的病原菌及耐药性分析

Analysis on distribution and drug resistance of pathogenic bacteria in biliary tract infection after endoscopic retrograde cholangiopancreatography

目的分析内镜逆行胰胆管造影（ERCP）术后胆道感染的病原菌分布及其耐药性，为临床预防治疗提供参考。方法回顾性分析医院2011年1月-2014年1月1644例行内镜逆行胰胆管造影术患者的临床资料，调查患者术后胆道感染、病原菌分布及其耐药性，采用全自动细菌鉴定仪进行菌种鉴定，药敏试验采用纸片扩散（K-B）法，药敏试验结果判定严格按照美国临床实验室标准化委员会制定的标准执行。结果1644例ERCP患者发生胆道感染66例，感染率为4．01％；共分离出病原菌79株，其中革兰阴性菌56株占70．89％、革兰阳性菌23株占29．11％；革兰阴性菌对亚胺培南和美罗培南的耐药率均为0，而对头孢菌素类抗菌药物耐药率为60．00％～70．00％，革兰阳性菌对替考拉宁和呋喃妥因耐药率均为0。结论ERCP术后患者胆道感染病原菌以革兰阴性菌为主，大多病原菌呈多药耐药性，临床选用抗菌药物应按药敏试验结果，选用合理抗菌药物，有利于改善患者预后；避免滥用广谱抗菌药物，减少耐药菌株的产生。

OBJECTIVE To analyze the distribution and drug resistance of pathogenic bacteria in biliary tract infection after endoscopic retrograde cholangiopancreatography, and to provide the reference for clinical prevention and treatment. METHODS Totally 1644 patients were treated with endoscopic retrograde cholangiopancreatography in our hospital from Jan. 2011 to Jan. 2014 whose clinical data were retrospectively analyzed. The biliary tract infection, distribution and drug resistance of pathogenic bacteria were investigated. The automatic bacterial identifier was used for bacterial identification and the K-B disk diffusion method was used for the drug sensitive test and the results were assessed in accordance with the criteria by the National Committee for Clinical Laboratory, RESULTS There were 66 cases with biliary tract infection in the 1644 patients, and the infected rate was 4.01%. Totally 79 strains of pathogenic bacteria were separated and identified, including 56 strains of gram- negative bacteria （70.89 %） and 23 strains of gram-positive bacteria （29.11%）. The gram-negative bacteria were highly sensitive to imipenem and meropenem with the resistance being 0, and were highly resistant to cephalosporins with the resistance of 60. 00%- 70. 00%. The gram-positive bacteria were highly sensitive to teicoplanin and nitrofurantoin with the resistance being 0. CONCLUSION Most of pathogenic bacteria were belonged to gram-negative bacteria in biliary tract infection after endoscopic retrograde cholangiopancreatography, and showed multi-drug resistance. The reasonable selection of antibacterials according to the result of drug sensi- tivity test is beneficial for improving the prognosis of patients and reducing the production of drug resistance strains