内镜逆行胰胆管造影术后胆道感染病原菌分布及耐药性分析

Distribution and Drug Resistance of Pathogenic Bacteria in Biliary Tract Infections after Endoscopic Retrograde Cholangiopancreatography

目的分析内镜逆行胰胆管造影术后胆道感染的病原菌分布及耐药性,为临床合理用药提供参考。方法回顾性分析2019年1月-2020年6月某院经内镜逆行胰胆管造影术患者705例,对术后胆道感染患者胆汁或血液进行细菌培养,应用SPSS19.0软件统计分析其病原菌分布及其耐药性。结果649份胆汁样本,共鉴定分离出病原菌721株,其中革兰阳性菌182株(25.24%),革兰阴性菌539株(74.76%);537份血液样本,共鉴定分离出病原菌218株,其中革兰阳性菌42株(19.27%),革兰阴性菌176株(80.73%)。病原菌分布主要为革兰阴性菌,占76.14%,以大肠埃希菌、肺炎克雷伯杆菌、铜绿假单胞菌为主;其次为革兰阳性菌,占23.86%,以粪肠球菌为主。药敏试验结果显示主要革兰阴性菌对头孢菌素普遍耐药率较高,对喹诺酮类耐药率较高,对亚胺培南、美罗培南耐药率较低;主要革兰阳性菌对利奈唑胺、万古霉素耐药率为0。结论本组内镜逆行胰胆管造影术后胆道感染患者以革兰阴性菌感染为主,并对临床常用抗菌药物产生耐药,因此,临床治疗应根据本地区病原菌分布及耐药情况慎重选择抗菌药物,提高治疗效果,减少耐药菌的产生。

Objective To analyze the distribution and drug resistance of pathogenic bacteria in biliary tract infections after endoscopic retrograde cholangiopancreatography,and provide reference for clinical rational drug use.Methods The clinical data of 705 patients who had undergone endoscopic retrograde cholangiopancreatography in our hospital between January 2019 and June 2020 was retrospectively analyzed.Bacterial culture in the bile or blood of enrolled patients with postoperative biliary tract infections was performed,and SPSS19.0 software was used to analyze the distribution of pathogens and their drug resistance statistically.Results In the 649 bile samples,a total of 721 strains of pathogenic bacteria were identified and separated,including 182 strains of gram-positive bacteria(25.24%)and 539 strains of gramnegative bacteria(74.76%).In the 537 blood samples,218 strains of pathogenic bacteria were cultured,in which there were 42 strains of gram-positive bacteria(19.27%)and 176 strains of gram-negative bacteria(80.73%).Gram-negative bacteria were the dominating pathogenic bacteria(accounting for 76.14%),including Escherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa,followed by gram-positive bacteria(accounting for 23.86%),most of which were Enterococcus faecalis.Drug susceptibility test results showed that the main gram-negative bacteria had a high universal resistance rate to cephalosporins,a high resistance rate to quinolones,and a low resistance rate to imipenem and meropenem.The main gram-positive bacteria were resistant to cephalosporins,but linezolid and vancomyci were not resistant at all.Conclusion Most of the pathogenic bacteria are gram-negative bacteria in biliary tract infections after endoscopic retrograde cholangiopancreatography,and are obviously resistant to clinically commonly-used antibiotics.Therefore,the distribution and drug resistance of pathogenic bacteria should be taken into consideration during the selection of antibacterial drugs for clinical treatment in order to improve the therapeutic effect and reduce the production of drug resistant bacteria.