胆道感染患者胆汁标本分离的病原体及其耐药性

目的了解胆道感染患者胆汁中常见病原体及其对抗菌药物的耐药性，为临床选择抗菌药物治疗提供参考。方法 对2011年5月-2013年5月收集的胆汁标本，采用法国生物梅里埃公司的VITEK2 COMPACT全自动微生物鉴定仪进行细菌鉴定和药敏试验，并对药敏结果采用WHONET5.3软件进行统计分析。结果共收集445份胆汁标本,其中阳性标本254份,阳性率57.08%。共分离病原体306株，其中革兰阴性（G-）菌231株(75.49%)，革兰阳性（G+）菌58株(18.95%)，真菌17株(5.56%)。引起胆道感染常见的G-菌依次为大肠埃希菌(21.89％)、肺炎克雷伯菌(18.30％)、铜绿假单胞菌(13.40％)； G+菌为粪肠球菌(5.56％)、凝固酶阴性葡萄球菌(3.59％)、屎肠球菌(3.59％)等。G-菌对亚胺培南、厄他培南耐药率最低，其次为头孢替坦、阿米卡星、哌拉西林/他唑巴坦；对喹诺酮类、青霉素类、头孢菌素类有较高的耐药性。G+菌对万古霉素耐药率最低,对利奈唑胺耐药率较低，对其他抗菌药物都有不同程度的耐药(30％～90％)。结论胆道感染细菌以G-杆菌为主；定期获得可靠的细菌耐药性动态监测数据，对临床经验性治疗和制定针对分离菌的治疗方案均有重要意义。

Distribution and antimicrobial resistance of pathogens from bile specimens from patients with biliary tract infection

ObjectiveTo investigate the distribution and antimicrobial resistance of pathogens from bile specimens from patients with biliary tract infection, and provide reference for clinical antimicrobial use.MethodsBile specimens collected from May 2011 to May 2013 were cultured, identification and antimicrobial susceptibility testing of the isolated bacteria were performed by VITEK2 COMPACT automatic system, antimicrobial susceptibility data were analyzed using the WHONET 5.3 software.ResultsOf 445 cultured bile specimens, 254 (57.08%) were positive for bacterial culture. A total of 306 pathogenic isolates were obtained, 231 (75.49%) of which were gram negative strains，58 (18.95%) were gram positive strains, and 17(5.56%) were fungi. The most common gram negative pathogens in biliary tract infection were Escherichia coli(21.89%), Klebsiella pneumoniae(18.30%)，and Pseudomonas aeruginosa (13.40%); the most common gram positive pathogens were Enterococcus faecalis (5.56％)，coagulase negative Stahylococcus (3.59％),and Enterococcus faecium (3.59％)．Antimicrobial resistant rate of gram negative bacteria to imipenem and ertapenem was the lowest, followed by cefotetan, amikacin, and piperacillin /tazobactam;the resistant rates to quinolones,penicillins,and cephalosporins were high. Antimicrobial resistant rate of gram positive bacteria to vancomycin was the lowest, followed by linezolid, the resistant rates to other antimicrobial agents were 30%-90%.ConclusionThe major pathogens in biliary tract infection are gram negative bacilli, regular monitor on antimicrobial resistance is important for the treatment.