老年患者胆汁培养病原菌分布及耐药性分析

Analysis of the distribution and drug resistance of pathogenic bacteria from bile specimens of elderly patients

目的研究老年患者胆汁培养中分离病原菌的构成和耐药性,为临床合理使用抗菌药物提供依据。方法收集2014年1月~2016年12月中国医科大学附属盛京医院(以下简称"我院")老年患者胆汁培养标本进行菌株鉴定和药敏试验,并进行回顾性分析。结果共分离出病原菌268株,其中革兰阴性菌191株,革兰阳性菌73株,真菌4株。检出率排在前6位的细菌分别为大肠埃希菌、屎肠球菌、肺炎克雷伯菌、粪肠球菌、鲍曼不动杆菌和铜绿假单胞菌。大肠埃希菌和肺炎克雷伯菌对碳青霉烯类、氨基糖苷类、头孢吡肟、头孢他啶、头孢替坦和哌拉西林/他唑巴坦的耐药率均低于50.00%;鲍曼不动杆菌对亚胺培南的耐药率高达86.67%,而对替加环素和阿米卡星的耐药率较低;铜绿假单胞菌对头孢吡肟和头孢他啶的耐药率分别为14.29%和38.46%。屎肠球菌和粪肠球菌对利奈唑胺、替加环素和万古霉素均高度敏感,屎肠球菌对多种抗菌药物的耐药率高于粪肠球菌。结论我院老年患者胆道感染以革兰阴性菌为主,阿米卡星可作为首选用药;对于肠球菌属的感染,万古霉素和利奈唑胺具有较高的抗菌活性。临床上应根据药敏结果合理选用抗菌药物,提高治疗效果。

Objective To investigate the distribution and drug resistance of pathogenic bacteria from bile specimens of elderly patients, in order to provide guidance for clinical rational use of antibiotics. Methods Identification of bacteria and antibiotic susceptibility tests were performed on the strains isolated from elderly patients in Shengjing Hospital of China Medical University （＂our hospital＂ for short） from January 2014 to December 2016, and the results were analyzed retrospectively. Results There were 268 strains of pathogenic bacteria from bile specimens, including 191 strains of Gram-negative bacteria and 73 strains of Gram-positive strains and 4 strains of fungi, of which the top 6 pathogens were Escherichia coli, Enterococcus faecium, Klebsiella pneumoniae, Enterococcus faecalis, Acinetobacter baumannii and Pseudomonas aeruginosa. The drug resistance rates of Escherichia coli and Klebsiella pneumoniae to Carbapenems, Aminoglycosides, Cefepime, Ceftazidime, Cefotetan, Piperacillin-tazobactam were lower than 50.00%. The drug resistance rate of Acinetobacter baumannii to Imipenem was 86.67%, while to Tigecycline and Amikacin were lower. The resistant rate of Pseudomonas aeruginosa to Cefepime and Ceftazidime was 14.29% and 38.46% respectively. The drug resistance rates of Enterococcus faecium to many antibiotic drugs were higher than Enterococcus faecalis. Both of them were sensitive to Linezolid, Tigecycline, Vancomycin. Conlusion The most common pathogens from bile specimens of elderly patients in our hospital are Gram-negative strains, Amikacin may be the first choice antibiotics. For infection of the Enterococcus spp,Vancomycin and Linezolid have higher antimicrobial activities. The antimicrobial agents should be chosen reasonably according to the results of the drug susceptibility to improve the effect of the treatment.