急性胆道感染患者胆汁标本病原菌分布及其耐药性

目的:分析急性胆道感染患者胆汁标本病原菌分布及其耐药性。方法:选取294例急性胆道感染患者为研究对象,均采集胆汁标本,进行病原菌培养、分离鉴定和药敏试验,统计病原菌分布情况,并分析主要革兰阴性菌和革兰阳性菌对抗菌药物的耐药性。结果:294份胆汁标本共分离出468株病原菌,其中革兰阴性菌占比最高(71.37%),革兰阳性菌次之(26.07%),真菌最低(2.56%)。大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌对氨苄西林的耐药性均最高,其中,大肠埃希菌对氨苄西林的耐药率为85.71%,其次是莫西沙星(71.43%);肺炎克雷伯菌对氨苄西林的耐药率为84.78%,其次是莫西沙星(71.74%);铜绿假单胞菌对呋喃妥因、氨苄西林的耐药性最高(100.00%),其次是头孢曲松(90.70%);鲍曼不动杆菌对氨曲南的耐药性最高(100.00%),其次是头孢噻肟(76.19%);屎肠球菌对利福平的耐药性最高(100.00%),其次为红霉素(95.00%);粪肠球菌对利福平、奎奴普丁/达福普汀的耐药性最高(100.00%),其次为四环素(80.00%)。屎肠球菌对替考拉宁、替加环素、万古霉素和利奈唑胺的耐药性较低,均<2%;粪肠球菌对替加环素、利奈唑胺、呋喃妥因和氨苄西林的耐药性较低,均为0。结论:急性胆道感染患者胆汁标本病原菌分布以革兰阴性菌为主,对氨苄西林、莫西沙星、呋喃妥因等药物耐药性较高,且存在多重耐药现象;临床应根据患者具体药敏试验结果,选用敏感性抗菌药物,减少抗菌药物滥用、泛用等不良现象。

Distribution and drug resistance of pathogenic bacteria in bile specimens of patients with acute biliary tract infection

Objective:To analyze distribution and drug resistance of pathogenic bacteria in bile specimens of patients with acute biliary tract infection.Methods:294 patients with acute biliary tract infection were selected as the research subjects,and the bile specimens were collected from all of them.The pathogenic bacteria were cultured,isolated and identified.The drug sensitive test was performed.The distribution of pathogenic bacteria was statistically analyzed.Then,the resistance of major gram-negative and gram-positive bacteria to the antibiotics was analyzed.Results:468 pathogenic bacteria were isolated from the 294 bile specimens,among which,the proportion of Gram-negative bacteria was the highest(71.37%),followed by Gram-positive bacteria(26.07%),and the proportion of fungi were the lowest(2.56%).Escherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa all had the highest resistance to Ampicillin,among which,the resistance rate of Escherichia coli to ampicillin was 85.71%,followed by Moxifloxacin(71.43%).The resistance rate of Klebsiella pneumoniae to Ampicillin was 84.78%,followed by Moxifloxacin(71.74%).Pseudomonas aeruginosa had the highest resistance to Nitrofurantoin and Ampicillin(100.00%),followed by Ceftriaxone(90.70%).Acinetobacter baumannii had the highest resistance to Aztreonam(100.00%),followed by cefotaxime(76.19%).The resistance of Enterococcus faecium to Rifampicin was the highest(100.00%),followed by Erythromycin(95.00%).The resistance of Enterococcus faecalis to Rifampicin,Quinupristin and Dalfopristin was the highest(100.00%),followed by Tetracycline(80.00%).The resistance of Enterococcus faecium to Teicoplanin,Tigecycline,Vancomycin and Linezolid was low,all<2%.Further,the resistance of Enterococcus faecalis to Tigecycline,Linezolid,Nitrofurantoin and Ampicillin was low,all being zero.Conclusions:The pathogenic bacteria in the bile specimens of the patients with acute biliary tract infection is mainly gram-negative bacteria,which are highly resistant to Ampicillin,Moxifloxacin,Nitrofurantoin and other drugs,and there are multiple antibacterial resistance phenomenon.Therefore,the clinical physicians should select the sensitive antibacterial drugs based on the specific drug susceptibility test results in order to reduce the abuse and general use of the antibacterial drugs.