老年胆道结石患者术后胆汁标本细菌分布及耐药性分析

Analysis of bile bacteria spectrum and drug resistance in elderly patients with biliary tract stones after operation

目的分析老年胆道结石患者术后胆汁标本细菌分布及对抗菌药物的耐药性。方法选择2020年1月—2021年9月铜陵市人民医院肝胆外科81例胆道结石术后的患者胆汁样本,进行细菌鉴定和药敏试验。结果81例老年胆道结石术后患者,胆汁标本细菌培养阳性36例,共培养出细菌44株。胆管结石患者胆汁标本细菌培养阳性率[57.9%(22/38)]高于胆囊结石患者[32.6%(14/43)],两者相比P<0.05;≥70岁患者胆汁标本细菌培养阳性率[65.90%(29/44)]高于≥60~70岁患者[18.91%(7/37)],两者相比P<0.05。在分离的44株细菌中,革兰阴性菌25株(56.81%),以大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌为主;革兰阳性菌19株(43.18%),以粪肠球菌、屎肠球菌为主;同时发现多例多重耐药菌,以产超广谱β内酰胺酶大肠埃希菌及肺炎克雷伯菌为主。在细菌敏感及耐药方面,普通革兰阴性菌对头孢类、喹诺酮类、氨基糖甙类药物等普遍敏感,其中喹诺酮类药物敏感率最高(100%,16/16),而多重耐药菌对以上药物普遍耐药,对美洛培南(66.67%,6/9)、哌拉西林/他唑巴坦(55.56%,5/9)的敏感率最高;革兰阳性菌对红霉素(31.58%,6/19)、利福平(42.11%,8/19)敏感率最低,对青霉素(63.16%,12/19)、氨苄西林(68.42%,13/19)敏感率也不高,以利奈唑胺(100%,19/19)、替考拉宁(94.74%,18/19)敏感率最高。结论老年胆道结石的感染好发于胆管结石及高龄老人,该类患者围手术期应重视抗感染治疗;胆道结石的感染致病菌以革兰阴性菌为主,首选喹诺酮类药物,如果存在耐药,应首选美洛培南、哌拉西林/他唑巴坦、利奈唑胺。

Objective To analyze the bacterial distribution and antimicrobial resistance in bile specimens of elderly patients with biliary tract stones after operation.Methods From January 2020 to September 2021,postoperative bile samples from 81 patients with biliary tract stones in the Department of Hepatobiliary Surgery of Tongling People’s Hospital were selected for bacterial identification and drug susceptibility testing.Results Among the 81 elderly patients with bile tract stones,36 were positive for bacterial culture.The positive rate of patients with bile duct stones was higher than that of patients with gallbladder stones(57.9%vs 32.6%,P<0.05).The positive rate in patients aged≥70 years was higher than that in patients aged≥60-70 years(65.90%vs 18.91%,P<0.05).Among the 44 isolated bacteria,25(56.81%)were gram-negative bacteria,mainly Escherichia coli,Klebsiella pneumoniae,and Enterobacter cloacae;19(43.18%)were gram-positive bacteria,mainly fecal Enterococcus and Enterococcus faecium.At the same time,multiple cases of multidrug-resistant bacteria were found,mainly extended-spectrumβ-lactamase(ESBLs)-producing Escherichia coli and Klebsiella pneumoniae.In terms of bacterial susceptibility and resistance,the gram-negative bacteria were generally sensitive to cephalosporins,quinolones,and aminoglycosides,among which quinolones had the highest sensitivity rate(100%,16/16),however,multidrug-resistant bacteria were generally resistant to the above drugs,with the highest sensitivity rate to meropenem(66.67%,6/9),piperacillin/tazobactam(55.56%,5/9).The lowest sensitive drug to gram-positive bacteria were erythromycin(31.58%,6/19),rifampicin(42.11%,8/19),meanwhile,the sensitivity rate to penicillin(63.16%,12/19)and ampicillin(68.42%,13/19)were not high either,elinezolid(100%,19/19)and teicoplanin(94.74%,18/19)had the highest sensitivity rates.Conclusions The infection of biliary tract stones in the elderly is more common in bile duct stones and the advanced age,anti-infective treatment should be paid attention in the perioperative period of these patients.Gram-negative bacteria are the main pathogens for the infection of biliary tract stones,and quinolones are the first choice,if drug resistance exists,meropenem,piperacillin/tazobactam,and linezolid should be preferred.