某院113例胆道感染患者胆汁病原菌分布及耐药谱描述

Distribution of pathogenic bacteria and drug resistance spectrum analysis of bile in patients with biliary duct infection

目的分析胆道感染患者胆汁培养及药物敏感性试验结果,为临床抗菌药物合理使用提供依据。方法本研究选择2016年7月至2017年12月南方医科大学第五附属医院治疗的113例胆道感染患者为样本。其中男71例,女42例,平均年龄(44±13)岁。收集所有患者的胆汁进行细菌、真菌培养并进行药物敏感性(药敏)试验分析。结果共分离培养出113株病原菌,其中革兰阴性菌占71.8%,革兰阳性菌占28.2%,未培养出真菌。病原菌前5位分别是大肠埃希菌(31.0%)、肺炎克雷伯菌(18.6%)、粪肠球菌(13.3%)、铜绿假单胞菌(11.5%)及屎肠球菌(9.7%)。革兰阴性菌对碳青霉烯类药物耐药率较低;革兰阳性菌对万古霉素、利奈唑胺、替加环素表现出高敏感性,而对红霉素、克林霉素敏感性较低。结论胆道感染仍以革兰阴性菌为主,临床症状较轻的患者选用含β-内酰胺酶抑制剂的抗菌药物,中、重度感染者可考虑给予碳青霉烯类药物治疗。胆道感染时,可以首先根据病原菌分布及药敏试验结果及时调整用药。

Objective To analyze the results of bile cultures and drug sensitivity tests in patients with biliary ductinfection in a hospital so as to provide reference for clinical use of antibiotics.MethodsOne hundred and thirteen patientsdiagnosed as hepatobiliary disease complicated with biliary duct infection in the 5th Affiliated Hospital of Southern MedicalUniversity from July 2016 to December 2017 were elected in this study. There were 71 males and 42 females with a meanage of(44±13) years. The bile specimens from all the patients were collected, and the bacterial and fungal cultures and drugresistance analysis were performed.ResultsTotally 113 pathogens were isolated and cultured, including 71.8% of gram-negative pathogens and 28.2% of gram-positive pathogens, but no fungi. The top five pathogens were Escherichia coli(31.0%), Klebsiella pneumonia(18.6%), Enterococcus faecalis(13.3%), Pseudomonas aeruginosa(11.5%), and Enteroccocusfaecium(9.7%). The drug resistance rate of gram-negative bacteria to carbapenems was low. Gram-positive pathogens re-vealed highly sensitive to vancomycin, linezolid, and tigecycline, whereas less sensitive to erythrocin and clindamycin.ConclusionGram-negative pathogens are the dominant pathogens in biliary duct infection. In the initial treatment, antibioticscompound with β-lactamaseinhibitor should be chosen. For serious patients, carbapenems may be considered. Gram-positivepathogens also have a certain proportion in biliary duct infection. The antibiotic drugs should be adjusted according to the re-sults of bacterial cultures and drug sensitivity tests in the clinical treatment.