某院胆管感染患者胆汁中病原菌分布及对药物敏感性的分析研究

Analysis of Pathogen Distribution and Drug Sensitivity in Bile of Patients with Bile Duct Infection in A Hospital

目的分析胆管感染患者胆汁中病原菌的分布及对药物敏感性的变化效果。方法选取我院2017年6月至2018年12月收治的胆管感染患者270例,穿刺取胆汁进行细菌培养与药物敏感性试验并分析结果。结果270例胆管感染患者中检出病原菌103例,总阳性率为38.15%。其中急性胆管感染患者,检出阳性率为57.25%;慢性胆管感染患者,检出阳性率为18.18%;混合细菌感染发生率约14.56%。共分离到病原菌118株,病原菌构成比较大的分别为大肠埃希菌31株(26.27%)、肺炎克雷伯菌24株(21.19%)、阴沟肠杆菌1株(7.63%)、屎肠球菌13株(11.02%),粪肠球菌10株(8.47%),真菌5株(4.24%)。革兰阴性杆菌对碳青霉烯类的敏感性最高,其次为头孢替坦、妥布霉素、哌拉西林/舒巴坦钠和阿米卡星类药物较敏感。屎肠球菌对多种抗生素耐药率远高于粪肠球菌,对达福普汀、利奈唑烷、替加环素全部敏感。粪肠球菌对达福普汀全耐药,对万古霉素、利奈唑烷、替加环素全部敏感。结论对于慢性胆管感染患者只围手术期预防感染使用抗生素即可;对于急性胆管感染患者,需根据术中胆汁培养和药物敏感性试验结果选择合适的抗菌药物进行治疗。

Objective To analyze the distribution of pathogenic bacteria in bile and the effect of drug sensitivity changes in patients with bile duct infection.Methods Select our June 2017 to December 2018 treated 270 cases of patients with biliary infection,piercing take bile bacteria culture and drug sensitivity test and analysis results.Results 103 cases of pathogenic bacteria were detected among 270 patients with bile duct infection,and the total positive rate was 38.15%.The positive rate was 57.25%in patients with acute bile duct infection.The positive rate of patients with chronic bile duct infection was 18.18%.The incidence of mixed bacterial infection was about 14.56%.A total of 118 strains of pathogenic bacteria were isolated,including 31 strains of Escherichia coli(26.27%),24 strains of Klebsiella pneumoniae(21.19%),1 strain of Enterobacter cloacae(7.63%),13 strains of enterococcus faecalis(11.02%),10 strains of enterococcus faecalis(8.47%)and 5 strains of fungi(4.24%).Gram-negative bacilli were the most sensitive to carbapenems,followed by cefotetan,tobramycin,piperacillin/Sulbactam sodium and amikacin.The drug resistance rate of enterococcus faecalis was much higher than that of enterococcus faecalis.Enterococcus faecalis was completely resistant to Dafoputin and sensitive to vancomycin,linezolid and tegacycline.Conclusion Only perioperative antibiotics should be used to prevent infection in patients with chronic bile duct infection.For patients with acute bile duct infection,appropriate antimicrobial agents should be selected according to the results of intraoperative bile culture and drug sensitivity test.