胆道感染患者胆汁病原菌分布及耐药性分析

Distribution and drug resistance of pathogens in patients with biliary tract infection

目的了解胆道感染患者胆汁病原菌分布以及耐药情况,为临床抗菌药物的选择提供参考。方法将2014年9月至2016年8月解放军第八五医院胆道感染患者胆汁培养阳性的143株病原菌的分布及耐药情况采用WHONET5.4软件进行统计分析。结果革兰阴性杆菌占53.8%(77/143),革兰阳性球菌占44.1%(63/143),真菌属占2.1%(3/143)。引起胆道感染常见的病原菌依次为粪肠球菌(12.6%,18/143)、屎肠球菌(11.9%,17/143)、肺炎克雷伯菌(11.2%,16/143)、大肠埃希菌(9.1%,13/143)、铜绿假单胞菌(8.9%,12/143)等。药敏结果显示:革兰阴性杆菌对碳青霉烯类药物、阿米卡星的耐药率较低;革兰阳性球菌对利奈唑胺、达托霉素及万古霉素的耐药率较低。结论胆道感染中的革兰阴性杆菌仍占主要地位,革兰阳性球菌呈上升趋势,临床常用的抗生素的耐药性明显增加,要有针对性地合理选用抗生素。

Objective To investigate the distribution and drug resistance of pathogen in patients with biliary tract infection,and to guild clinical application of antibiotics.Methods The cases of biliary tract infection with positive bile pathogen culture in our hospital from September 2014 to August 2016 were retrospectively analyzed,and the distribution and drug resistance of 143 strains of pathogen from those cases were statistically analyzed using WHONET5.4.ResultsAmong the 143 strains of pathogen,there were 77（53.8%）gram-negative bacilli,63（44.1%）gram-positive coccus and 3（2.1%）fungal strains.The most common pathogenic bacteria in biliary tract infection were Enterococcus faecalis（12.6%,18/143）,Enterococcus faecium（11.9%,17/143）,Klebsiella pneumoniae（11.2%,16/143）,Escherichia coli（9.1%,13/143）and Pseudomonas aeruginosa（8.9%,12/143）.The susceptibility tests revealed that resistant rates of gramnegative bacilli against amikacin and doripenem were fairly low,and of gram-positive coccus against linezolid,daptomycin and vancomycin were also fairly low.Conclusion In biliary tract infection,the infectious rate of gram-positive coccus increased year by year,though the rate of gram-negative bacilli took the lead invariably.Clinical selection of antibiotics should be more reasonable and specific,as the pathogen developed resistance to the most common antibiotics obviously.