胆道感染患者胆汁培养细菌分布特征及耐药性

Distribution and antimicrobial resistance of bile bacteria cultrue in patients with biliary tract infection

目的分析胆道感染患者的一般临床体征、致病菌分布及药敏试验结果,为临床治疗感染提供参考。方法回顾并分析2018年1月—2021年12月上海健康医学院附属周浦医院收治的131例胆道感染患者的诊疗过程,整理和统计分析患者的基础信息(年龄、性别、疾病诊断)、临床分离菌种及药敏试验结果。结果131例胆道感染患者以胆结石伴胆道感染多见,其中60岁以上老年患者102例,占比明显高于中青年患者(77.9%比22.1%,P<0.05)。胆汁样本中共分离细菌159株,其中革兰阴性(G^(-))菌占比57.2%,以大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌为主;革兰阳性(G^(+))球菌占比42.8%,以肠球菌属为主。G^(-)杆菌对常用广谱青霉素、头孢菌素(除四代外)的耐药率均高于30.0%,大肠埃希菌对氨苄西林的耐药率较高(53.3%)。G^(-)菌对氨基糖苷类、碳青霉烯类药物的敏感率均高于80.0%,其中产超广谱内酰胺酶(ESBL)大肠埃希菌的检出率明显高于肺炎克雷伯菌,分别为30.0%、12.5%;耐碳青霉烯类肠杆菌目(CRE)的检出率为1.3%。G^(+)球菌对氟喹诺酮类、青霉素类药物均有较高的敏感性,除鹑鸡肠球菌和铅黄肠球菌对万古霉素天然耐药外,未检出万古霉素、利奈唑胺耐药株。结论该院胆道感染患者以老年人为主。胆汁培养分离中G^(-)菌多见,大肠埃希菌、克雷伯菌属、肠球菌属为主要病原菌。不同时期和不同种类细菌的耐药性有所不同,因此定期监测胆道感染患者胆汁致病菌的分布及耐药谱,可有效指导临床抗感染治疗。

Objective To analyze the general clinical signs,pathogenic bacteria distribution and antibiotic susceptibility of patients with biliary tract infection,so as to provide reference for clinical treatment of infection.Methods The diagnosis and treatment process of 131 patients with biliary tract infection admitted to Zhoupu Hospital Affiliated to Shanghai University of Medicine and Health Sciences from January 2018 to December 2021 was retrospectively analyzed.The basic information(age,gender and diagnosis),clinical isolates and results of antibiotic susceptibility test were collected and statistically analyzed.Results Among 131 patients,gallstones with biliary tract infection were the most common,and 102 patients were over 60 years old,the proportion was significantly higher than that of young and middle^(-)aged patients(77.9%vs.22.1%,P<0.05).The 159 strains of bacteria were isolated from bile sample,57.2%were Gram negative(G^(-))bacteria(mainly Escherichia coli,Klebsiella pneumoniae and Enterobacter cloacae),and 42.8%of Gram positive(G^(+))cocci(mainly Enterococcus spp.).The resistant rate of G^(-)bacilli to commonly used broad^(-)spectrum Penicillin and Cephalosporin(except the fourth generation)was higher than 30.0%,and the resistance rate of Escherichia coli to Ampicillin was higher(53.3%).The sensitivity to aminoglycosides and carbapenems was higher than 80.0%.The detectable rates of extended^(-)spectrumβ^(-)lactamase(ESBL)producing Escherichia coli and Klebsiella pneumoniae were 30.0%and 12.5%,Carbapenem^(-)resistant Enterobacteriaceae(CRE)were isolated,and the detectable rate was 1.3%.G^(+)cocci were highly sensitive to fluoroquinolones and penicillins and were not found to be resistant to Vancomycin and Linezolid(except for Enterococcus gallinarum and Enterococcus flavus naturally resistant to vancomycin).Conclusions The patients with biliary tract infection in the hospital are mainly elderly patients.G^(-)bacteria are mainly isolated from bile culture,among which Escherichia coli,Klebsiella spp.and Enterococcus spp.are the main pathogens.The antimicrobial resistance status of different types of bacteria in different periods is different.Therefore,regular monitoring of the distribution and antimicrobial spectrum of bile pathogens in patients with biliary tract infection could effectively guide clinical anti^(-)infective treatment.