急性胆管炎患者胆汁培养结果和药敏分析

目的研究急性胆管炎患者胆汁培养的病原学现状,病原体分布特点以及药敏情况为急性胆管炎的治疗提供更为合理的抗生素指导方案。方法回顾性分析2015年1月~2018年1月湛江地区我院收治符合病例研究纳入标准共314例急性胆管炎患者的临床病例资料,对其胆汁培养的病原菌分布及耐药性进行分析。结果 314例急性胆管炎胆汁培养的病原菌阳性率为82.80%,共检出病原菌358株,革兰氏阴性菌230株,革兰氏阳性菌122株,真菌6株。最常见的细菌是大肠埃希菌129株(36.0%)、粪肠球菌59株(16.5%)、铜绿假单胞菌27株(7.5%)、肺炎克雷伯菌肺炎亚种24株(6.7%)以及屎肠球菌17株(4.7%)。胆道培养为革兰氏阴性致病菌总体上对碳氢酶烯类(厄他培南耐药率0%,亚胺培南耐药率8.41%,美罗培南耐药率22.22%)及氨基糖苷类(阿米卡星耐药率1.35%,庆大霉素耐药率20.00%、妥布霉素10.19%)相对敏感度较高。胆道培养为革兰氏阳性致病菌总体上对临床上常用的大部分抗生素耐药率较低,譬如对米诺环素、莫西沙星、氨苄西林、头孢曲松耐药率均低于10%。而对于临床上较少应用的抗菌素如克林霉素、红霉素耐药率则高于40%。结论急性胆管炎患者胆汁培养的病原学现状仍然以革兰阴性菌为主,而药敏以碳氢酶烯类及氨基糖苷类相对敏感度较高,故临床上对其应用抗菌素治疗时要重视加强管理及监控。

Pathogenic status and drug sensitivity analysis of bile culture in patients with acute cholangitis

［Abstract］ Objective To profile the types of bacteria in bile culture and study their antibiotic sensitivity pattern in patients of acute cholangitis, and to provide guidance for reasonable clinical use of antibiotics. Methods A retrospective analysis was conducted on 314 patients with acute cholangitis from January 2015 to January 2018 satisfied the inclusion criteria. And the pathogen distribution and drug resistance were analyzed. Results The overall positive rate of 314 patients with acute cholangitis was 82.80%. Totally, 358 strains of pathogens were detected, gram-positive bacteria were 230 strains, gram-native bacteria were 122 strains, fungi were 6 strains. The most common pathogens were e. coli （129 strains, 36.03%）, enterococcus faecalis（59 strains, 16.48%）, pseudomonas aeruginosa （27 strains, 7.54%）, klebsiella pneumonia （24 strains, 6.70%）, and enterococcus faecalis （17 strains, 4.75%）. When the pathogenic bacteria in bile culture were gram-negative bacteria, the relatively sensitive drugs were carbapenems （drug resistance rate respectively were Ertapenem 0% imipenem 8.41% meropenem 22.22%） and aminoglycosides （drug resistance rate respectively were amikacin 1.35% gentamicin 20.00% tobramycin 10.19%）. While the pathogenic bacteria in bile culture were gram-positive bacteria, the drug resistance is relatively light, which are lower than 10% among minocycline, moxifloxacin, ampicillin and ceftriaxone. However, the drug resistance of antibiotics such as clindamycin and erythromycin are higher than 40%. Conclusion In the present paper, the types of bacteria in bile culture among patients with acute cholangitis were mainly gram-native bacteria. And the relatively sensitive drugs are hydrogenase-enes and enterococcus faecalis. It is necessary to strengthen the management and monitoring of the application of antibiotics in clinical practice.