2017—2018年周口市中心医院急性结石性胆管炎患者胆汁病原菌的分布及耐药性分析

Analysis on distribution and drug resistance of pathogenic bacteria from patients with acute calculous cholangitis in Zhoukou Central Hospital from 2017 to 2018

目的了解周口市中心医院急性结石性胆管炎患者胆汁病原菌的分布和耐药性,为临床抗感染治疗提供依据。方法对221例胆总管结石并急性胆管炎患者术中获取的胆汁进行病原菌培养,并对病原菌的分布和耐药性进行分析。结果共分离出病原菌190株,革兰阴性菌174株,构成比为91.6%,主要为大肠埃希菌、肺炎克雷伯菌和醋酸钙不动杆菌。革兰阳性菌16株,构成比为8.4%,主要为粪肠球菌。大肠埃希菌对亚胺培南完全敏感,对阿米卡星和美罗培南的敏感率高达95%以上,对氨苄西林、复方新诺明、头孢呋辛、头孢曲松、头孢噻肟、头孢唑林的耐药率高达80%以上。醋酸钙不动杆菌主要对美满霉素、多黏菌素B、米诺环素敏感,对头孢哌酮/舒巴坦、诺氟沙星完全耐药,对左氧氟沙星、环丙沙星、哌拉西林、氨苄西林/舒巴坦、庆大霉素、头孢噻肟、头孢他啶耐药率较高。粪肠球菌对链霉素(高浓度)和左氧氟沙星完全敏感,对阿奇霉素、复方新诺明、头孢吡肟、头孢曲松的耐药率为100.0%。结论周口市中心医院急性结石性胆管炎病原菌感染率较高,建议临床医师根据病原学监测资料有针对性地选择抗生素,以指导抗菌药物的合理使用。

Objective To understand the distribution and drug resistance of pathogenic bacteria from patients with acute calculous cholangitis in Zhoukou Central Hospital, to provide evidence for clinical anti-infection treatment. Methods Bacterial culture of bile from 221 cases of patients with cholelithiasis and acute cholangitis was conducted to understand the distribution and drug resistance of pathogenic bacteria. Results A total of 190 strains of pathogens were isolated. Gram-negative(174 strains) accounted for 91.6%, and main of them were Escherichia coli, Klebsiella pneumonia, and Acinetobacter calcoaceticus. Gram-positive bacteria bacteria were 16 strains(8.4%), and main of them were Enterococcus faecalis. E. coli was completely sensitive to imipenem. The sensitive rates of E. coli against amika and meropenan were above 95%. The drug resistance rates of E. coli against ampicillin, sulfamethoxazole, cefuroxime, ceftriaxone, ceftaxime, and cefazolin were above 80%. A. calcoaceticus was sensitive to myxomycin, polymyxin B, and minocycline, completely resistant to cefoperazone/sulbactam and norfloxacin. The drug resistance rates of A. calcoaceticus against levofloxacin, ciprofloxacin, piperacillin, ampicillin/sulbactam, gentamicin, cefotaxime, and ceftadime were higher. E. faecalis was completely sensitive to streptomycin(high concentration) and levofloxacin. The drug resistance rates of E. faecalis against azithromycin, sulfamethoxazole, cefepime, and ceftriaxone were 100.0%. Conclusion The infection rate of acute calculus cholangitis in Zhoukou Central Hospital is high. Doctors should select the antibiotics based on the etiology of monitoring data for rational use of antibiotics.