胆道感染的病原菌分布及耐药分析

Bistribution and Antimicrobial Susceptibility of Pathogenic Bacteria of Biliary Tract Infection

目的通过了解胆道感染的病原菌分布及其对抗生素敏感性的情况,为临床合理用药提供依据。方法对我院肝胆外科住院患者胆汁培养阳性的137株细菌分布及药敏结果采用WHONET 5.6软件进行统计分析。结果 137株胆汁培养阳性的细菌中,革兰阴性杆菌120株占87.6%,革兰阳性球菌17株占12.4%,引起胆道感染常见的病原菌主要为大肠埃希菌73株占53.3%,肺炎克雷伯菌25株占18.3%,铜绿假单胞菌12株占8.8%,大肠埃希菌对美罗培南、亚胺培南无耐药菌株,头孢哌酮/舒巴坦耐药率为12%、哌拉西林/他唑巴坦为8%、耐药率较低,对氨苄西林的为87.6%、头孢唑林为65.9%、哌拉西林为60.6%、头孢呋辛为60.2%,耐药率较高。肺炎克雷伯菌对美罗培南、亚胺培南无耐药菌株,对头孢吡肟耐药率为9.8%、头孢哌酮/舒巴坦为5%,耐药率较低,对氨苄西林、哌拉西林为天然耐药。铜绿假单胞对阿米卡星耐药率为13%、哌拉西林/他唑巴坦为8.6%、亚胺培南为1.1%、美罗培南0.2%、,耐药率较低。对氨苄西林、氨苄西林/舒巴坦、头孢曲松、头孢呋辛、头孢唑林、复方磺胺为天然耐药。结论胆道感染中革兰阴性杆菌仍占主要地位,细菌耐药谱有较大差异,建议临床医师根据病原学监测结果针对性地选择抗菌药物。

Objective To understand the distribution and antimicrobial susceptibility of pathogenic bacteria of biliary tract infec- tion, and to provide the basis for the clinical medication. Methods By using the WHONET 5.6 software to statistically analyze the dis- tribution and drug sensitive tests of 137 strains of pathogenic bacteria cultured by bile cultivation, and all of themwere from patients with liver and gallbladder surgery in our hospital in 2012.4 to 2014.6. Results In the 137 positive strains in bile culture, the leading pathogen was Gram -negative bacillus, 120 strains（ 87.6% ） ,followed by Grame -positive bacteria, 17 strains（ 12.4% ） , and the main pathogenic bacteria of purulent cholangitis were Escherichia coli 73 strains, accounting for 53.3% , Klebsiella pneumoniae 25 strains, accounting for 18.3 %, and Pseudomonas aeruginosa 12 strains, which take 8.8%. of which E. coli was all sensitive to meropenem and imipenem, and had a low resistance rate to Cefperazone/sulbactam（ 12% ）and Piperacillin/tazobactam（ 8% ） , but had a higher resist- ance rate to Ampicillin （ 87.6% ） , cefazolin（65.9% ） , Piperacillin （ 60.6% ） and Cefuroxime （ 60.2% ）. In addition, Klebsiella pneu- mon^ae was all sensitive to meropenem and imipenem, too. For Cefepime and Cefperazone/Sulbactam it had a lower resistance rate, by 9.8% and 5.0% , respectively. However, it＇ s initial resistance were Ampicillin and Piperacillin.. The esistant rate of Pseudomonas aeruginosa was 13 %, 8.6% , 1.1% and 0.2% to Amikacin, Piperacillin/tazobactam, Imipenem, Meropenem, respectively, they all were low. Ampicillin, Ampicillin/Sulbactam, Ceftriaxone, Cefuroxime, Cefazolin and Sulfamethoxazole were it＇ s initial resistance. Conclu- sion The biliary tract infections are mainly caused by gram negative bacilli, and there is greater variation in bacterial drug resistant spectrum, so clinicians should use the result of pathological surveillance to chose antibacterial drugs with care.