胆道感染患者胆汁培养与药敏分析和抗生素的选择应用

目的分析胆道感染患者胆汁中细菌群情况及其对抗生素的敏感性,为临床选择抗生素提供指导。方法将2004年1月至2005年12月住院患者胆汁培养阳性的326株细菌的分布及药敏结果采用WHONET5.3软件进行统计分析。结果革兰阴性杆菌占54%(176/326),革兰阳性球菌占42.6%(139/326),真菌属占3.4%(11/326)。引起胆道感染常见的病原菌依次为大肠埃希菌(23.6%,77/326),屎肠球菌(12.6%,41/326),粪肠球菌(10.4%,34/326),葡萄球菌(10.1%,33/326),肺炎克雷伯菌(6.7%,22/326)等。药敏结果显示:革兰阴性菌对亚胺培南总耐药率最低(12%),其次为美洛培南(12.1%),头孢哌酮-舒巴坦(16.6%),阿米卡星(19.1%),而对氨苄西林,哌拉西林,氨苄西林-舒巴坦,头孢唑啉,环丙沙星等高度耐药。革兰阳性菌对万古霉素及替考拉宁耐药最低(0),其次为氯霉素(12%),呋喃妥因(15.6%),磷霉素(18.2%)。结论胆道感染中的革兰阴性杆菌仍占主要地位,革兰阳性球菌呈上升趋势,临床常用的抗生素的耐药性明显增加,要有针对性地合理选用抗生素。

Biliary germiculture and antibiotic susceptibility test in biliary tract infection patients and the selection of antibiotics

Objective To survey the biliary pathogenic bacteria and their resistance to antibiotics in biliary tract infection patients.Methods The data of 326 strains of pathogen isolated from the positive bile culture during January 2004 to December 2005 and their sensitivity to antibiotics were statistically analyzed by WHONET 5.3.Results A total of 326 strains were identified including 176 Gram negative strains (54%,176/326),139 Gram positive strains(42.6%,139/326),and 11 fungal strains (3.4%, 11/326 ).The most common pathogenic bacteria were Escherichia coli (23.6%,77/326),Enterococcus faecium( 12.6%,41/326),Enterococcus faecalis(10.4%,34/326),Staphylococcus( 10.1%,33/326), and Klebsiella pneumoniae(6.7%,22/326).The results of drug susceptibility showed the resistant rates of Gram negative strains to imipenem was (12%) followed by meropenem (12.1%),cefoperazone and sulbaetam(16.6%) and amikacin(19.1%).In this study Gram negative strains were highly resistant to ampieillin,piperacilin,ampicillin and sulbaetam,cefazolin,and ciprofloxacin.None of Gram positive strains was resistant to vancomycin and teicoplanin,and the resistant rates to chloromycetin,nitrofurantoin, fosfomyein was 12%,15.6%,and 18.2%,respectively.Conclusions Gram negative strains remain most common in biliary tract infection,but the rate of Gram positive strains is rising.