237例胆道感染患者病原菌的分布构成及耐药性情况研究

Research on the distributions and drug resistance of pathogenic bacteria in 237 patients with biliary tract infection

目的了解胆道感染患者胆汁病原菌的分布构成及耐药情况,指导临床上抗菌药物的使用。方法收集我院2016年1月至2017年1月行手术治疗的237例胆道感染患者的胆汁标本,进行细菌培养,对分离的病原菌进行细菌鉴定及药敏试验。结果237例胆汁标本中共检出156株病原菌,病原菌检出阳性率为65.8%。其中革兰氏阳性菌(G+菌)占比37.8%,以粪肠球菌(13.5%)和屎肠球菌(9.6%)为主;革兰氏阴性菌(G-菌)占比62.2%,以大肠埃希菌(24.4%)、肺炎克雷伯菌(15.4%)及铜绿假单胞菌(10.3%)为主。G-菌对头孢菌素类抗生素和广谱青霉素类抗生素耐药率较高,对碳青霉烯类抗生素无耐药株产生。G+菌对替考拉宁及利奈唑胺均未检出耐药株,屎肠球菌发现1例万古霉素耐药株。G+菌中粪肠球菌和屎肠球菌对喹诺酮类抗生素、利福平及四环素的耐药性较高,且葡萄球菌属对青霉素G及氨苄西林有较高的耐药性。结论237例胆道感染患者病原菌以革兰阴性菌为主,病原菌中大肠埃希菌、肺炎克雷白杆菌及肠球菌为主要病原菌,病原菌耐药性增强,应加强对胆道感染患者病原菌的监测及药敏试验,指导临床有针对性地合理应用抗菌药物。

Objective To understand the distributions and drug resistance of pathogenic bacteria in patients with biliary tract infection and provide the clinical basis in the usage of anti-bacterial agents.Methods The bile specimen for 237 patients with biliary tract infection treated from January 2016 to January 2017 in our hospital were collected and cultured.The pathogenic bacteria were separated to make the bacterial identification and drug sensitivity test.Results For 237 bile specimen,there were 156 strains of pathogenic bacteria;the positive detection rate of pathogenic bacteria was 65.8%which it was dominated by the gram-positive bacterium(G+bacteria)(37.8%),Enterococcus faecalis(13.5%)and Enterococcus faecium(9.6%);the rate of gram-negative bacterium(G-bacteria)was 62.2%which it was dominated by Escherichia coli(24.4%),Klebsiella pneumoniae(15.4%)and Pseudomonas aeruginosa(10.3%).The G-bacteria had a higher drug resistance on the cephalosporins antibiotics and broad-spectrum penicillins antibiotics;there was no persister on the carbapenem antibiotics.The persister of G+bacteria on the teicoplanin and linezolid was not detected.There was one persister of Enterococcus faecium on the Vancomycin.For G+bacteria,the Enterococcus faecalis and Enterococcus faecium had a higher drug resistance on the quinolones antibiotics,rifampicin and tetracycline;the staphylococcus had a higher drug resistance on the penicillin G and Ampicillin.Conclusion For patients with biliary tract infection,the G-bacteria is dominated including Escherichia coli,klebsiellar pneumonia and enterococcus.The drug resistance of pathogenic bacteria is increased;therefore,it is necessary to monitor the pathogenic bacteria,conduct the drug sensitivity test,and apply the special anti-bacterial agents.