胆总管结石患者胆汁病原菌分布特点及耐药性分析

目的:探讨胆总管结石患者胆汁病原菌的分布特点以及耐药性的分析。方法:选择2016年6月-2017年6月期间我院收治的胆总管结石合并胆道感染患者160例为研究对象,所有患者均进行逆行内镜胰胆管造影(ERCP)并抽取胆汁标本,进行细菌培养和耐药性实验,评价分析胆汁病原菌的分布特点及耐药性情况。结果:160例患者中有117例(73.13%)检出病原菌,共培养出病原菌130株,其中有13例患者为两种病原菌同时感染。革兰阴性菌有95株(73.08%)、革兰阳性菌有31株(23.85%)、真菌有4株(3.08%)。比例由高到低的前六位病原菌依次为:大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、屎肠球菌、铜绿假单胞菌、粪肠球菌。革兰阴性菌对亚胺培南、阿米卡星、美罗培南、他唑巴坦、头孢吡肟等三四代头孢菌素耐药率较低,对头孢曲松、环丙沙星、左氧氟沙星、哌拉西林、氨苄西林等耐药率较高。革兰阳性菌对替拉考宁、万古霉素、利奈唑胺等耐药率较低,对四环素、环丙沙星、左氧氟沙星、克林霉素、氨苄西林等耐药率较高。真菌对酮康唑、伊曲康唑、氟康唑等耐药率较低,对两性霉素B耐药率较高。结论:胆总管结石患者胆汁病原菌主要为革兰阴性菌、其次为革兰阳性菌,各病原菌对各种抗菌药物表现出不同的耐药性,因此在临床治疗时应参考药敏试验结果进行合理选择治疗药物。

Distribution of Bile Pathogens and Analysis of Drug Resistance in Patients with Choledocholithiasis

ABSTRACT Objective: To investigate the distribution characteristics of bile pathogenic and analysis of drug resistance in patients with choledocholithiasis. Methods: A total of 160 cases of choledocholithiasis combined with biliary tract infection, who were treated in the First Affiliated Hospital of Chengdu Medical College from June 2016 to June 2017, were selected as research subjects. All the patients were treated with retrograde endoscopic cholangiopancreatography (ERCP) and extracted the bile samples and bacterial culture and drug resistance experiment were conducted, the distribution characteristics and drug resistance of bile pathogens were analyzed. Results: Among 160 patients, 117 patients (73.13%) were detected pathogenic bacteria, and 130 bacteria were cultured, of which 13 were infected by two bacteria; there were 95 strains of Gram-negative bacteria (73.08%), 31 strains of Gram-positive bacteria (23.85%), 4 strains of fungi (3.08%). The first six pathogens from high to low were in turn: escherichia coli, klebsiella pneumoniae, enterobacter cloacae, ente- rococcus faecium, pseudomonas aeruginosa and Enterococcus faecalis. The resistance rates of Gram-negative bacteria to imipenem, meropenem, Amikacin, tazobactam, cefepime and three or four generation cephalosporin were lower, the resistance rates to ceftriaxone, ciprofloxacin, levofloxacin, piperacillin and ampicillin were higher. The resistance rates of Gram positive bacteria to Lakaoning, van- comycin, linezolid and other were lower, the resistance rates to tetracycline, ciprofloxacin, levofloxacin, clindamycin and ampicillin were higher. The resistance rates of fungi to ketoconazole, itraconazole and fluconazole were lower, and the resistance rate to amphotericin B was higher. Conclusion: The main pathogenic bacteria in the bile of patients with choledocholithiasis are Gram-negative bacteria, the sec- ond is Gram-positive bacteria. The pathogenic bacteria showed different resistance to various antibacterials; therefore, in the clinical treatment, drugs should be reasonably chosen according to the results of drug sensitivity test.