457例不同胆道疾病胆汁微生物培养及抗菌药物耐药性比较分析

Microbiological culture and resistance analysis of bile from 457 cases with different biliary tract diseases

目的分析中山大学孙逸仙纪念医院近3年不同胆道疾病胆汁中微生物分类及药敏情况,指导胆道感染疾病的合理用药。方法 457例胆汁进行微生物培养,鉴定及药物敏感性试验,分析胆汁微生物学分布及药敏特点。结果 249例胆汁细菌培养阳性,共分离鉴定出370株细菌,革兰阴性菌234株(63.3%),革兰阳性菌123株(33.2%),真菌13株(3.5%)。其中,胆石症组206株(55.7%),胆道恶性肿瘤组146株(39.5%),其他良性疾病组18株(4.8%)。胆石症患者推荐选择碳青霉烯类和酶抑制剂复方制剂类抗生素,胆道恶性肿瘤患者可选择氨基糖苷类、氟喹诺酮类、第四代头孢或碳青霉烯类抗生素,胆道良性疾病选用碳青霉烯类和酶抑制剂复方制剂。结论本院不同胆道疾病胆汁微生物分布相似但耐药谱存在差异,不同的胆道疾病胆道感染应选择不同的抗生素进行治疗。

Objective To investigate the microorganism classification and drug sensitivity of bile from different biliary tract diseases in Sun Yat-sen Memorial Hospital,Sun Yat-sen University in the past three years,and guide the rational use of antibiotics in biliary tract infection. Methods Microbial culture,identification and drug sensitivity tests were carried out in457 cases of bile to analyze the microbial distribution and drug sensitivity characteristics of bile. Results A total of 370 strains of bacteria,234 strains( 63. 3%) of gram-negative bacteria,123 strains( 33. 2%) of gram-positive bacteria and 13 fungal bacteria( 3. 5%) were isolated and identified in 249 cases of bile with positive bacteria culture. There were 206 strains( 55. 7%) in the cholelistasis group,146 strains( 39. 5%) in the biliary malignant tumor group and 18 strains( 4. 8%) in the benign disease group. Carbapenems and enzyme inhibitor compound antibiotics are recommended for cholelithiasis patients;aminoglycosides,fluoroquinolones,fourth-generation cephalosporins or carbapenems antibiotics can be selected for biliary malignant tumors;carbapenems and enzyme inhibitor compound preparations are recommended for biliary benign diseases.Conclusion The microbial distribution of bile in different biliary diseases in our hospital is similar but the drug resistance spectrum is different. Different biliary infections should be treated with different antibiotics.