2012年全国三级医院胆汁培养病原菌的构成及耐药性分析

Bacterial distribution and resistance in biliary tract infections of the tertiary hospitals of China in 2012

目的：分析我国胆道感染病原菌分布及对常用抗菌药的耐药现状。方法对2012年全国557家三级医院胆汁培养中分离的病原菌进行耐药检测，数据用WHONET 5.6软件进行统计分析。结果共分离出细菌13596株，革兰氏阳性球菌3698株，占27.2％，其中最常见的是粪肠球菌1237株（9.1％）和屎肠球菌1198株（8.8％）；革兰氏阴性杆菌9898株，占72.8％，其中最常见的是大肠埃希菌4311株（31.7％），肺炎克雷伯菌1518株（11.2％）和铜绿假单胞菌839株（6.2％）。大肠埃希菌和肺炎克雷伯菌对氨苄西林的耐药率最高，达79.0％～87.1％；对头孢噻肟的耐药率分别为70.6％，55.8％；对头孢吡肟的耐药率分别为28.7％，18.4％；对碳青霉烯类药物耐药率低于10％。铜绿假单胞菌对亚胺培南及美罗培南的敏感率分别为61.1％和65.7％。粪肠球菌和屎肠球菌对万古霉素的耐药率分别为2.5％和1.3％。结论我国胆道病原菌以大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌等肠杆菌科细菌最多见。

Objective To understand the bacteria distribution of biliary tract infections and drug resistance in China.Methods Antimicrobial susceptibility test for strains isolated from bile culture were performed in 557 hospitals in china.WHONET 5.6 software was used for statistical analysis.Results A total of 13596 bacterial strains were isolated, inclu-ding gram-positive cocci 3698 strains, accounting for 27.2%, gram-negative bacilli 9898 strains, accounting for 72.8%.The top two gram-positive cocci are Enterococcus faecalis 1237 strains （9.1%） and Entero-coccus faecium 1198 strains （8.8%）.The top three gram-negative ba-cilli are Escherichia coli 4311 strains （ 31.7%） , Klebsiella pneumoniae 1518 strains （ 11.2%） and Pseudomonas aeruginosa 839 strains （6.2%） .The highest resistant rates of Escherichia coli and Klebsiella pneumoniae is ampicillin, amounting to 79.0% -87.1%; The resis-tance rates to cefotaxime of Escherichia coli and Klebsiella pneumoniae were 70.6% and 55.8 % respectively, and the resistance rates to cefepime were 28.7% and 18.4% respectively.The sensitive rates to imipenem and meropenem of Pseudomonas aeruginosa were 61.1% and 65.7%respectively.The resistance rates to vancomycin of Enterococcus faecalis and Enterococcus faecium were 2.5% and 1.3% respectively. Conclusion The most common pathogens of biliary infections are Escherichia coli, Klebsiella pneumonia, Pseudomonas aeruginosa and other Enterobacteriaceae.