胆道疾病患者胆汁菌群分布及耐药分析

Biliary pathogenic distribution and drug resistance in patients with biliary diseases

目的探讨本地区胆道疾病患者胆汁菌群分布和药敏试验结果的相关因素与胆汁培养阳性率的关系。方法收集本院2010年1月至2015年12月326例胆道疾病患者胆汁进行细菌培养和药物敏感性试验。结果 2010至2012年、2013至2015年两个时间段140份和186份胆汁标本中分别有73和118份检出致病菌,阳性率为52.1%和63.4%。分别检出致病菌85株和140株;分离的致病菌以革兰阴性(G-)杆菌为主,两个时间段分别占74.1%和68.6%;革兰阳性(G+)菌分别占24.7%和28.6%。老年患者、有临床症状、既往手术史、ERCP史、结石、良性胆道疾病患者、手术时间≥3 h患者的培养阳性率高。药物敏感试验结果显示,G-杆菌对亚胺培南、美洛培南耐药率最低,对青霉素类、喹诺酮类、部分三代头孢菌素类等抗菌药物耐药率较高(均>50.0%)。G+球菌对万古霉素、利奈唑胺、达托霉素耐药率为0,对青霉素类、喹诺酮类和红霉素等抗菌药物耐药率较高(均>40.0%)。结论胆道疾病患者分离的致病菌以G-杆菌为主,对常用抗菌药物耐药率较高;需重视引起胆汁培养高阳性率的临床因素。

Objective To investigate the biliary pathogenic distribution and drug susceptibility in patients with biliary tract disease in our district, and to analyze the correlation between the positive rate of germiculture and the influence factors. Methods Bile specimens collected from 326 patients with biliary tract diseases from January 2010 to December 2015 were cultured and tested for drug sensitivity. Results There were 73 and 118 positive samples, respectively, among 140 samples during the first half of this study （2010- 2012） and 186 samples during the second half （2013-2015）, as well as 85 and 140 strains cultured. Isolated pathogenic bacteria were mainly Gram-negative bacteria, which accounted for 74.1% and 68.6% and Gram- positive accounted for 24.7% and 28.6% during both pariods. Patients who were older, with signs of biliary infection, biliary surgery history, biliary ERCP history, gallstones, benign biliary tract disease and long surgery times were with a higher positive rates. Susceptibility test showed that resistant rates of Gram-negative strains to imipenem and meropenem were the lowest; Gram-negative strains were highly resistant to penicillins, quinolones, some third generation cephalosporins and so on （all 〉 50.0%）. None of Gram-positive strains were resistant to vancomycin, teicoplanin and daptomycin. They were highly resistant to penicillins, quinolones and erythromycin （〉 40.0%）. Conclusions Gram-negative strains were the commonest pathogens in biliary tract disease, which had a high resistant rate to the commonly used antibiotics. The clinical factors of high positive rate of bile bacterial cultur should be paled attention to.