老年胆道感染患者胆汁中菌群情况及耐药性

Bacterial flora distribution and drug resistance in bile of elderly patients with biliary tract infection

目的探讨老年胆道感染患者胆汁中细菌菌群的分布情况及各常见菌群耐药性,为临床治疗提供更可靠的理论指导。方法收集2017年1月至12月住院的胆道感染患者100例(观察组),分别经皮经肝胆囊穿刺引流/经皮经肝胆管穿刺引流或胆道手术等方式无菌留取胆汁标本进行相关细菌学培养和细菌的鉴定。另选取同期进行健康体检的100例为对照组。采用全自动生化分析仪检测血清中C反应蛋白(CRP)水平,用ELISA检测血清中白介素(IL)-6和肿瘤坏死因子(TNF)-α水平并比较。结果本研究行胆汁细菌培养100例,其中85例培养出细菌生长,阳性率为85. 00%(85/100),共培养出病原菌102株,其中最常见的为革兰阴性菌92株(90. 20%),药敏实验提示大部分革兰阴性菌对亚胺培南、美罗培南等抗菌药物敏感性高;大部分致病菌对第二、三代抗菌药物均有较高的耐药率;另外,研究中10株革兰阳性菌中的9例肠球菌均对替考拉宁敏感,对目前临床一线使用的抗菌药物均有较高的耐药率,其中红霉素、氨苄西林的耐药率最高,分别为77. 78%、66. 67%。观察组血清IL-6、TNF-α和CRP水平均高于对照组,差异有统计学意义(P<0. 01)。结论胆道感染的病原菌多为肠道菌群中的革兰阴性菌,对碳青霉烯类(亚胺培南、美罗培南)敏感性高,临床治疗需密切结合致病菌分离培养及药敏实验结果。

Objective To explore the distribution of bacterial flora in bile of elderly patients with biliary tract infection and the resistance of common bacterial flora to provide more reliable theoretical guidance for clinical treatment. Methods By percutaneous transhepatic gallbladder drainage,percutaneous transhepatic biliary drainage or biliary tract surgery,the bile specimens were collected for bacteriological culture and bacterial identification from 100 patients with biliary tract infection treated from January 2017 to December 2017(observation group),and 100 cases of healthy subjects with physical examination over the same period were selected as control group. By automatic biochemical analyzer and ELISA,the serum level of CRP and IL-6 and TNF-α were detected,respectively and compared between two groups. Results In 100 bile specimens,there were 85 cases cultured for bacterial growth(85. 00%) with 102 strains of pathogenic bacteria,in which 92(90. 20%) isolates were Gram-negative bacteria. Drug sensitivity testing suggested that most Gram-negative bacteria had high sensitivity to imipenem and meropenem,and most common pathogenic bacteria had higher drug resistance to the second and third generation of antibiotics,10 strains of Gram-positive bacteria were 100% sensitive to teicoplanin. In the antibiotics used in the first-line treatment,the drug resistance rates of erythromycin(77. 78%) and ampicillin(66. 67%) were the highest. The serum levels of IL-6,TNF-α and CRP in observation group were significantly higher than those in control group(P< 0. 01). Conclusions Most of the pathogenic bacteria of biliary tract infection are Gram-negative bacteria in intestinal flora and are highly sensitive to piperacillin and advanced carbapenem. The clinical treatment should be performed fully considering the results of pathogen isolation and culture and drug sensitivity test.