348例肝胆疾病患者胆汁病原菌构成及耐药性分析

Pathogens distribution and antibiotic resistance analysis from bile culture in 348 patients with hepatobiliary disease

目的了解肝胆系统疾病患者中胆汁病原菌构成比及其耐药性分析,以期指导临床合理选用抗菌药物。方法采用回顾性研究方法,收集2017年1～12月我院348例肝胆系统疾病患者送检的胆汁培养的细菌种类鉴定和药敏试验结果。结果送检胆汁培养标本348份,检出病原菌254株,其中革兰阴性菌194株(76. 38%),革兰阳性菌57株(22. 44%),真菌3株(1. 18%)。最常见的病原菌依次为大肠埃希菌69株(27. 17%)、肺炎克雷伯菌53株(20. 87%)、肠球菌36株(14. 17%)、阴沟肠杆菌20株(7. 87%)、铜绿假单胞菌和鲍氏不动杆菌各8株(3. 15%)。大肠埃希菌对亚胺培南、美罗培南、头孢哌酮/舒巴坦的耐药率最低,肺炎克雷伯菌对替卡西林-棒酸、阿莫西林/棒酸、头孢哌酮/舒巴坦的耐药率最低,阴沟肠杆菌对头孢吡肟、庆大霉素、哌拉西林/他唑巴坦、阿米卡星、美罗培南的耐药率最低。肠球菌中并未发现对万古霉素、利奈唑胺和达托霉素的耐药菌株。结论肝胆系统疾病患者胆汁中的病原菌对大多数常用抗菌药物均产生了不同程度的耐药性,临床应尽早根据药敏试验结果合理选用抗菌药物。

Objective To study the changes of biliary bacteria and their resistance to antibiotics in the bile samples of patients with hepatobiliary diseases. Methods A retrospective study was conducted to analyze biliary culture specimens from 348 patients with hepatobiliary diseases in our hospital from January to December 2017 for pathogens identification and antibiotics susceptibility test. Results Totally 254 strains of pathogens were isolated from 348 bile specimens, including 194 strains of gram-negative bacteria （76. 38% ）, 57 strains of gram-positive bacteria （22. 44% ） and 3 strains of fungi （ 1.18% ）. The most common pathogens were 69 strains of Escherichia coli （27. 17% ）, 53 strains of Klebsiella pneumoniae （20. 87% ）, 36 strains of Enterococcus （ 14. 17% ）, 20 strains of Enterobacter cloacae （7. 87% ）, 8 strains of Pseudomonas aeruginosa and Acinetobacter baumannii respectively （3.15%）. Escherichia coli showed the lowest resistance to imipenem, meropenem, and cefoperazone/sulbactam. Klebsiella pneumoniae showed the lowest resistance to ticarcillin-clavulanic acid, amoxicillin/clavulanic acid, and cefoperazone/sulbactam. Enterobacter cloacae showed the lowest resistance to cefepime, gentamicin, piperacillin/tazobactam, amikacin and meropenem. No strains were found to resistant to vancomycin, linazolamine and datoramycin in enterococcus. Conclusion The pathogens in bile of patients with hepatobiliary diseases have different degrees of drug resistance to the most commonly used antibiotics, and the antibiotics should be rationally selected according to the results of antibiotics susceptibility test.