经ERCP途径获取胆汁培养病原菌分布及耐药性分析

Distribution and drug resistance of pathogenic bacteria in culture of bile collected by ERCP

背景与目的:胆道感染是临床常见急腹症,处理不及时可引发感染性休克,甚至死亡。因此,了解胆道感染患者胆汁中细菌的种类及药敏情况对指导临床治疗至关重要。本研究分析胆道疾病患者经内镜逆行胰胆管造影(ERCP)途径获取胆汁培养病原菌分布及耐药情况,以期为临床胆道感染患者的抗菌药物合理使用提供依据。方法:回顾性分析2016年1月—2019年12月佛山市第一人民医院胆道外科收治的因胆道疾病行ERCP并进行胆汁培养和药敏检测的1141例病例资料,采用VITEK2-COMPACT全自动微生物鉴定药敏系统对患者胆汁中分离的菌株进行鉴定和药敏分析,并对胆石患者和非胆石患者的结果进行分析比较。结果:胆汁培养共分离出745株病原菌,其中革兰氏阴性菌488株(65.5%),革兰氏阳性菌195株(26.2%),真菌62株(8.3%)。前3位病原菌依次为大肠埃希菌、肺炎克雷伯菌和粪肠球菌,分别占33.4%,12.6%和8.2%。大肠埃希菌、肺炎克雷伯菌和粪肠球菌分别对甲氧苄啶、氨苄西林和克林霉素耐药率最高。大肠埃希菌、肺炎克雷伯菌和粪肠球菌在2016—2019年间对不同抗生素耐药情况出现不同程度变化。胆石患者发生胆道细菌感染比例高于非胆石患者(67.5%vs.58.8%),但非胆石患者更容易出现抗生素耐药。结论:胆道感染细菌的菌种构成和耐药情况均处在动态变化中,在临床治疗过程中应以胆汁培养与药敏结果为指导,合理使用抗生素,使患者最大程度获益,同时减少耐药菌株的产生。

Background and Aims:Biliary tract infection is a common acute abdominal disease.It can lead to septic shock and even death if not treated on time.So,knowledge of the bacterial species and their antimicrobial sensitivity patterns are critically important for guiding clinical treatment strategies.This study was conducted to analyze the distribution and drug resistance of pathogenic bacteria in bile culture obtained by endoscopic retrograde cholangiopancreatography(ERCP)in patients with biliary tract diseases,so as to provide basis for rational use of antibiotics in patients with biliary tract infection.Methods:The data of 1141 patients undergoing ERCP for biliary tract disease with bile culture and drug susceptibility test in Foshan First People’s Hospital from January 2016 to December 2019 were retrospectively analyzed.The identification of microbial strains isolated from the bile samples of the patients and drug susceptibility test were determined by VITEK2-COMPACT automatic microbial identification system.Further,the results between patients with gallstones and those without gallstones were analyzed and compared.Results:A total of 745 strains of pathogens were isolated from bile culture,including 488 types of gramnegative bacteria(65.5%),195 types of gram-positive bacteria(26.2%)and 62 types of fungi(8.3%).The top three pathogens were Escherichia coli,Klebsiella pneumoniae and Enterococcus faecalis,accounting for 33.4%,12.6% and 8.2%,respectively.The Escherichia coli,Klebsiella pneumoniae and Enterococcus faecalis showed the highest resistance rate to trimethoprim,ampicillin and clindamycin,respectively.The antibiotic resistance patterns of Escherichia coli,Klebsiella pneumoniae and Enterococcus faecalis to different antibiotics varied from 2016 to 2019.The incidence of biliary tract bacterial infection in patients with gallstones was higher than that in patients without gallstones(67.5%vs.58.8%),but patients without gallstones were more likely to develop antibiotic resistance.Conclusion:Both the bacterial species composition and their antibiotic resistance pattern of the pathogens of biliary infection are dynamically changed over time.Clinical treatment should be directed by bile culture and sensitivity test results,so as to ensure rational use of antibiotics,maximizing the benefit of patients and reducing the generation of drug-resistant strains.