恶性梗阻性黄疸患者胆汁细菌培养及耐药性分析

Pathogenic bacteria cultivating by bile from patients with malignant obstructive jaundice and drug resistance analysis

目的分析恶性梗阻性黄疸患者胆汁培养中主要致病菌的分布及其对抗菌药物的敏感情况,为临床合理用药提供参考依据。方法回顾性分析455例恶性梗阻性黄疸患者胆汁细菌培养及药敏试验结果。结果 455例恶性梗阻性黄疸患者中,116例患者胆汁细菌培养阳性,占全部病例的25.5%。共培养出25种147株细菌。其中革兰阴性杆菌118株,占80.3%;革兰阳性菌24株,占16.3%;真菌5株,占3.4%。革兰阴性杆菌对亚胺培南、美罗培南耐药率最低,其次为阿米卡星及头孢哌酮/舒巴坦;革兰阳性菌对利奈唑胺及万古霉素耐药最低。本组中产超广谱β内酰胺酶30株,占革兰阴性杆菌25.4%(30/118)。结论恶性梗阻性黄疸患者胆汁细菌以革兰阴性菌为主,细菌耐药性日趋严重,应及时按照药敏结果选择抗生素,从而提高胆道感染的治愈率。

Objective To analysis the distribution of main pathogenic bacteria cultivating by bile from malignant obstructive jaundice patients and their sensitivity to antibiotics so as to provide evidence for clinical reasonably use of antibiotics. Methods A total of 455 cases of malignant obstructive jaundice patients＇ results of the bacterial culture of bile and the drug susceptibility testing were retrospectively analyzed. Results There are 116 patients had a positive bile culture in 455 patients, the positive rate was 25.5%. Totally 147 strains were identified including 118 gram negative strains （80.3%, 118/147） and 24 gram positive strains （16.3%, 24/147）, 5 fungal strains （3.4%, 5/147）. The drug resistance rates of gram negative strains to imipenem and meropenem were the lowest, followed by amikacin, cefoperazone and sulbactam; the drug resistance rates of gram negative strains to linezolid and vancomycin were the lowest Of 118 gram negative strains,30 strains （25.4%） were ESBLs producers. Conclusions Malignant obstructive jaundice patients＂ results of the bacterial culture of bile were mainly gram negative strains. The antimicrobial resistance of pathogens was increasingly serioxis. So we should seasonably use of antibiotics according to the drug susceptibility to raise the clinical healing rate of biliary tract infection.