ERCP、PTCD患者胆汁标本病原菌检测及药敏分析

Pathogen detection and drug resistance analysis in patients after ERCP and PTCD treatment

目的:分析胆石症患者胆道感染的病原菌分布及耐药性,为临床合理用药提供参考。方法:2015年237例胆石症患者,通过经内镜逆行性胰胆管造影术(ERCP)或经皮经肝经胆囊穿刺引流术(PTCD)采集发生胆道感染患者的胆汁进行细菌培养,使用SPSS 13.0软件统计分析其病原菌分布及耐药性。结果:237例胆石症患者胆汁培养阳性163例,阳性率68.78%,其中革兰阴性菌161株,占87.50%,以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、阴沟肠杆菌为主;革兰阳性菌22株,占11.96%,以屎肠球菌(D群)为主;真菌1株,占0.54%。革兰阴性菌对阿米卡星耐药率最低为0,对碳青霉烯类抗菌药物有耐药性,大肠埃希菌、肺炎克雷伯菌对亚胺培南、美罗培南耐药率<5.00%,铜绿假单胞菌对亚胺培南、美罗培南耐药率<10.00%;三代头孢菌素在大肠埃希菌中耐药率较高;大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌对哌拉西林/他唑巴坦的耐药率分别为6.12%、15.38%、25.00%。革兰阳性菌屎肠球菌(D)对替加环素耐药率为0,对利奈唑烷耐药率较低为11.76%;在17株屎肠球菌(D)中发现1株对万古霉素耐药,耐药率为5.88%。胆汁中共检出大肠埃希菌和肺炎克雷伯菌134株,产超广谱β-内酰胺酶(ESBLs)的有43株,占32.09%;产ESBLs的大肠埃希菌和肺炎克雷伯菌对亚胺培南、美罗培南有较高的敏感性。结论:胆石症合并胆道感染患者以革兰阴性菌感染为主,致病菌对临床常用抗感染药物已产生严重的耐药现象,医院应按照《抗菌药物临床应用管理办法》加强抗菌药物管理,临床医生应提高抗菌药物使用前微生物送检率,根据本地区病原菌分布及耐药情况经验性选择抗菌药物。

Objective：To analyze the pathogen detection and drug resistance analysis in biliary tract infection in patients with cholelithiasis,and to provide reference for rational drug use in clinic.Methods：A total of 237 cases of cholelithiasis patients,bile were collected in patients with biliary tract infection through endoscopic retrograde cholangiopancreatography pancreatic（ERCP）or percutaneous transhepatic cholangial drainage（PTCD）for bacter culture,the pathogen distribution and drug resistance were analyzed by SPSS 13.0.Results：A total of 237 cases of cholelithiasis patients with positive bile culture of 163 cases,68.78% positive rate;the leather of gram negative bacteria 161strains（87.50%）,Escherichia coli,pneumonia grams Klebsiella pneumoniae,Pseudomonas aeruginosa,Enterobacter cloacae,the gram positive bacteria leather 22strains（11.96%）,Enterococcus faecium（Group D）;1case fungal strain（0.54%）.Leather gram negative bacteria of amikacin resistance as low as 0,to carbapenem antibiotics have drug resistance,Escherichia coli,pneumonia Klebsiella pneumoniae were resistant to imipenem and meropenem rate less than 5.00%,Pseudomonas aeruginosa strains to imipenem and meropenem resistant rate was lower than 10.00%;third generation cephalosporins in Escherichia coli resistance rate is higher;Escherichia coli,pneumonia gram Reber fungus,Pseudomonas aeruginosa bacteria to piperacillin piperacillin/tazobactam resistance rate was 6.12% and 15.38% and 25.00%.Leather gram positive bacteria Enterococcus faecium（D）for increase prostacyclin resistant rate was 0.Linezolid resistant rate lower 11.76%;in the 17 strains of Enterococcus faecium（D）found a strain resistant to vancomycin,drug resistance rate was 5.88%.Bile CPC detection of Escherichia coli and pneumonia 134 strains of Klebsiella pneumoniae and ESBLs have 43 strains,accounted for 32.09%;ESBLs producing Escherichia coli and pneumonia Klebsiella pneumoniae strains to imipenem and meropenem has higher sensitivity.Conclusion：Cholelithiasis associated with biliary tract infection patients to leather gram negative bacteria and pathogens of clinical anti infection drugs commonly used has produced serious resistance phenomenon,the hospital should be in accordance with the antibacterial drug clinical application management approach to strengthen the management of antimicrobial agents,clinicians should improve the anti bacteria drug use of microbial inspection rate according to the local area pathogen detection and drug resistance.