胆汁细菌药敏和抗菌药物应用调查

Investigation of antibacterial susceptibility of bacteria in bile and usage of antibacterials

目的调查胆道疾病患者胆汁中的细菌分布、药敏及抗菌药物应用合理性。方法收集2011年1月—2016年9月间收治的289例患者胆汁标本的细菌培养及药敏试验结果,回顾分析对这些患者应用抗菌药物的合理性。结果胆汁标本中细菌检出率为44.3%,其中革兰阴性菌占71.9%,革兰阳性菌占28.1%。居前5位的病原菌分别为大肠埃希菌(21.9%)、肺炎克雷伯菌(13.3%)、铜绿假单胞菌(10.1%)、粪肠球菌(9.4%)、阴沟肠杆菌(7.0%)。大肠埃希菌对大部分抗菌药物耐药,耐药率高;粪肠球菌对万古霉素、利奈唑胺、青霉素G耐药率低。用药频数(DDDs)居前5位的抗菌药物依次是是奥硝唑、头孢呋辛、头孢美唑、头孢吡肟、拉氧头孢。结论抗菌药物应用不完全符合细菌耐药监测结果;临床应重视胆汁微生物检查,参照胆汁培养及药敏试验结果有针对性地选择抗菌药物。

Objective To investigate the distribution and antibacterial susceptibility of bacteria in bile and the rational antibacterial use in patients with biliary tract diseases. Methods Data of biliary bacterial cultivation and drug-sensitivity tests of bile samples were collected from 289 patients in the department of general surgery of Tongi Hospital from January 2011 to September 2016. Their consumption of antibacterials were analyzed retrospectively. Results The positive bacteria rate of the samples was 44.3%. Gram-negative bacteria accounted for 71.9% and gram-positive bacteria accounted for 28.1%. The top five pathogens were Escherichia coli （21.9%） , Klebsiella pneumoniae （ 13.3% ） , Pseudomonas aeruginosa （ 10.1% ） , Enterococcus faecalis （9.4%） , and Enterobacter cloacae （7.0%）. Escherichia coli had a high rate of resistance. Enterococcusfaecalis had a low rate of resistance to vancomycin, linezolid, and penicillin G. The top five antibacterials sorted by DDDs were ornidazole, cefuroxime, cefmetazole, cefepime, and latamoxef. Conclusion The antibacterial selection is not fully justified by the results of bacterial cultivation and drug-sensitivity tests. Doctors should attach importance to microbiological examination of bile and use antibacterials according to the results of bacterial cultivation and drug-sensitivity tests.