2013—2016年胆道感染病原菌分布及耐药性分析

Distribution and Drug Resistance of Pathogenic Bacteria in Patients of Biliary Tract Infection from 2013 to 2016

目的:分析2013年—2016年天津市南开医院胆道感染患者胆汁病原菌分布及对抗生素的耐药性。方法:采用VITEK-2 compact微生物全自动分析仪进行细菌鉴定及药敏试验,并采用WHONET5.6软件进行分析。结果:胆汁培养阳性检出率为55.53%(2631/4738)。非重复临床分离的4539株病原菌中,革兰阴性菌占62.02%,革兰阳性菌占36.90%,真菌占1.08%。前6位致病菌是大肠埃希菌(26.06%)、肺炎克雷伯菌(11.87%)、屎肠球菌(10.58%)、粪肠球菌(10.22%)、铜绿假单胞菌(4.30%)和阴沟肠杆菌(3.90%)。大肠埃希菌和肺炎克雷伯菌的ESBLs检出率分别为54.27%和31.54%。碳青霉烯类耐药的大肠埃希菌和肺炎克雷伯菌的检出率为0.76%和0.93%。碳青霉烯类耐药的铜绿假单胞菌和鲍曼不动杆菌检出率分别为38.46%和28.97%。万古霉素耐药的屎肠球菌检出率0.63%。甲氧西林耐药的金黄色葡萄球菌(MRSA)及甲氧西林耐药的凝固酶阴性的葡萄球菌(MRCNS)检出率分别为56.04%和76.79%。结论:胆道感染患者病原菌以肠源性细菌为主,广泛耐药细菌种类逐渐增多,出现了广泛耐药的铜绿假单胞菌和鲍曼不动杆菌,碳青霉烯类耐药的大肠埃希菌和肺炎克雷伯菌,并且出现了万古霉素耐药的肠球菌。

Objective To investigate the distribution and antibiotic resistance of pathogenic bacteria trom the patients of biliary tract infection in Tianjin Nankai Hospital from 2013 to 2016 and provide the reference for clinical treatment. Methods The identification and the susceptibility test of the isolated bacteria were per- formed by the automatic VITEK-2 compact system, and the data was collected and analyzed using WHONET 5.6 software. Results The positive rate of bile culture was 55.53% （2631/4738）. A total of 4539 bacterial strains were isolated, including 2815 strains （62.02%） of Gram-negative bacilli, 1675（36.90% ） strains of Gram-positive cocci and 49（1.08%） strains of fungus. The top six bacteria were Escherichia coli （26.06%）, Klebsiella pneumonia （11.87%）, Enterococcus faecium （10.58%）, Enterocoecus faeealis （10.22%）, Pseudomonas aeruginosa （4.30%） and Enterobacter cloacae（3.90%）. Those of Escherichia coli and Klebsiella pneumonia pro- ducing ESBLs were 54.27% and 31.54% respectively. About the two kinds, the rates of resistance to carbapen- ems were 0.76% and 0.93%. About Pseudomonas aeruginosa and Acinetobacter baumannii,the rates of resis- tance to carbapenem were 38.46% and 28.97% respectively, about Enterococcus faecium, the rate of resistance to vancomycin was 0.63%. The detection rates of MRSA and MRCNS were 56.04% and 76.79%. Conclusion The most common pathogens in biliary tract infection were intestinal, the species of resistant pathogenic bacte- ria has increased gradually. The Pseudomonas aeruginosa and Acinetobacter baumannii, carbapenem resistant Escherichia coli and Klebsiella pneumonia, and vancomycin resistant enterococcUs （VRE） has appeared.