肝胆胰腺恶性肿瘤患者胆汁细菌培养病原菌分布及耐药性分析

Distribution and drug resistance of bacteria isolated from bile of patients with hepatobiliary pancreatic malignant tumor

目的分析肝胆胰腺恶性肿瘤患者发生胆道感染的病原菌分布及耐药特征,为临床合理应用抗菌药提供依据。方法回顾性对2015年1月—2019年12月天津市肿瘤医院肝胆胰腺恶性肿瘤患者胆汁培养结果进行分析。结果共纳入标本287例,检出菌株630株,分离出的革兰阴性菌为引起肝胆胰腺恶性肿瘤患者胆道感染的主要病原菌,占分离病原菌的比例为54.1%,其次为革兰阳性菌和真菌,分别占分离病原菌的39.4%、6.5%。检出的革兰阴性菌中以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、阴沟肠杆菌、鲍曼不动杆菌为主;检出的革兰阳性菌中以粪肠球菌、表皮葡萄球菌、屎肠球菌、鹑鸡肠球菌、溶血葡萄球菌为主;检出的真菌中以白色念珠菌为主。肠杆菌科细菌对碳青霉烯类、阿米卡星保持高度敏感,铜绿假单胞菌对碳青霉烯类抗菌药耐药率高,对阿米卡星保持高度敏感。葡萄球菌及肠球菌(对万古霉素天然耐药的鹑鸡肠球菌除外)对万古霉素及利奈唑胺高度敏感,葡萄球菌对苯唑西林耐药率高。结论肝胆胰腺恶性肿瘤患者胆道感染的主要致病菌为以肠杆菌及非发酵菌为主的革兰阴性菌,其次为以肠球菌、葡萄球菌为主的革兰阳性菌。肠杆菌、葡萄球菌、肠球菌的耐药率与其他医院既往研究相比略低或持平,但铜绿假单胞菌对碳青霉烯类抗菌药耐药率高于其他医院的既往研究,耐甲氧西林表皮葡萄球菌(MRSE)检出率与CHINET监测数据持平。

Objective To analyze the distribution and drug resistance of pathogens causing biliary tract infection in patients with hepatobiliary and pancreatic malignant tumors,so as to provide the basis for clinical rational use of antibiotics.Methods The bile culture results of patients with hepatobiliary pancreatic malignant tumor in Tianjin Cancer Hospital from January 2015 to December 2019 were retrospectively analyzed.Results A total of 287 samples were included and 630 strains were detected.The Gram-negative bacteria were the main pathogens causing biliary tract infection in patients with hepatobiliary and pancreatic malignant tumors,accounting for 54.1%of the isolated pathogens,followed by Gram-positive bacteria and fungi,accounting for 39.4%and 6.5%respectively.The main Gram-negative bacteria detected were Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,Enterobacter cloacae and Acinetobacter baumannii.Enterococcus faecalis,Staphylococcus epidermidis,Enterococcus faecium,Enterococcus gallinarum and Staphylococcus haemolyticus were the main Gram-positive bacteria detected.Candida albicans was the main fungus detected.Enterobacteriaceae was highly sensitive to carbapenems and amikacin,Pseudomonas aeruginosa had high resistance to carbapenems and high sensitivity to amikacin.Staphylococcus and Enterococci(except Enterococcus gallinarum naturally resistant to vancomycin)were highly sensitive to vancomycin and linezolid,and Staphylococcus was highly resistant to oxacillin.Conclusion The main pathogenic bacteria of biliary tract infection in patients with hepatobiliary and pancreatic malignant tumors were Gram-negative bacteria mainly composed of Enterobacter and non fermentative bacteria,followed by Gram-positive bacteria mainly composed of Enterococcus and Staphylococcus.The drug resistance rates of Enterobacteriaceae,Staphylococcus and Enterococci were slightly lower or flat compared with previous studies in other hospitals,but the resistance rate of Pseudomonas aeruginosa to carbapenems was higher than that of other hospitals.The detection rate of MRSE was the same as that of Chinet monitoring data.