200例肝胆管结石胆汁培养的临床资料分析

目的 分析肝胆管结石病胆道感染检出的病菌种类的病菌耐药变化情况。 方法 收集2008年1月—2017年12月收治的肝胆管结石患者初次胆汁细菌培养结果,比较前5年(A组)和近5年(B组)两组患者的胆汁培养结果在耐药菌种类及致病菌耐药率方面的差异。 结果 共检出革兰阴性菌155株(56.3%),革兰阳性菌120株(56.3%)。检出铅黄肠球菌37例,占革兰阳性菌的13.3%。分离量占前6位的病原菌依次为大肠埃希菌、粪肠球菌、铅黄肠球菌、肺炎克雷伯、铜绿假单胞菌和屎肠球菌。A,B组革兰阳性菌检出率分别为46%和65%。大肠埃希菌、肺炎克雷伯对头孢哌酮/舒巴坦及亚胺培南耐药率最低。头孢哌酮/舒巴坦及哌拉西林/他唑巴坦对铜绿假单胞菌敏感度>80%。大部分受试抗生素对粪肠球菌及铅黄球菌敏感率>90%,仅发现1例耐万古霉素肠球菌。 结论 肝胆管结石并感染仍以革兰阴性菌为主,革兰阳性肠球菌检出率呈上升趋势。铅黄肠球菌在本地区检出率较高,该菌种对万古霉素存在天然耐药,应予重视。头孢哌酮/舒巴坦联合环丙沙星/左氧氟沙星可覆盖绝大多数检出菌,可作为经验性治疗胆道感染时的首选联合用药方案。

Clinical Analysis of Bile Culture in 200 Patients with Hepatolithiasis

Objective To analyze the bacterial types and drug resistance in patients with hepatolithiasis and biliary tract infection. Method The results of bile culture in patients with hepatolithiasis admitted from January 2008 to December 2017 were collected, and the difference in the types of drug-resistance bacteria and resistance rate between the patients of previous 5 years(group A)and the last 5 years(group B)were compared. Result In this study, 155 gram-negative bacteria(56.3%)and 120 gram-positive bacteria(56.3%)were detected. Enterococcus casselifavus was detected in 37 cases accounting for 13.3% of Gram-positive bacteria. The pathogens that accounted for the top 6 in isolation were Escherichia coli, Enterococcus faecalis, Enterococcus casselifavus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Enterococcus faecium. The detection rate of Gram-positive bacteria in Group A and Group B was 46% and 65%, respectively. Escherichia coli and Klebsiella pneumoniae had the lowest resistance rates to cefoperazone/sulbactam and imipenem. Cefoperazon/Schubatam and piperacillin/tazobartan were sensitive to Pseudomonas aeruginosa with a sensitive rate > 80%. Most of the antibiotics tested were sensitive to Enterococcus faecalis and Enterococcus casselifavus with a sensitive rate >90%, in which only one case with Enterococcus resisted to vancomycin. Conclusion Gram-negative bacteria still predominates in the biliary tract infection caused by hepatolithiasis, with an increasing detection rate of Gram-positive enterococci. The detection rate of Enterococcus casselifavus is high in this area and it has natural resistance to vancomycin, which needs more attention. Cefoperazon/Schubatan combined with ciprofloxacin/levofloxacin can cover the majority of bacteria detected in the bile of the patients with hepatolithiasis and biliary tract infection, which can be used as the preferred therapeutic regimen of experimental treatment.