广西桂林、柳州地区胆汁细菌培养菌谱及药物敏感试验对比研究

目的对广西相邻两地区桂林与柳州市胆道疾病患者胆汁中病原菌分布及药物敏感（药敏）情况进行对比研究，为两地区临床合理用药提供依据。方法回顾性调查分析2011年5月-2013年5月两地区两所大型三级甲等医院内胆道疾病患者术中留取胆汁进行需氧菌培养且用法国生物梅里埃公司细菌数值分类分析鉴定系统进行鉴定以及纸片药敏扩散法进行药敏测定的临床资料。结果两医院近两年内分别进行了129例及63例胆汁细菌培养，阳性率分别为44．18％、53．96％。桂林地区共培养出65株病原菌，前5位依次是：大肠埃希菌25株、粪肠球菌14株、肺炎克雷伯肺炎亚种9株、屎肠球菌6株、铜绿假单胞菌4株。柳州地区共培养出43株病原菌，前5位依次是：大肠埃希菌19株、铜绿假单胞菌8株、产气肠杆菌5株、摩根摩根菌3株、鲍氏不动杆菌2株，两地区产超广谱13内酰胺酶的肠杆菌呈逐年增加趋势。两地区G’球菌对万古霉素、氨苄西林、青霉素敏感性较好；G-菌对亚胺培南、阿米卡星、头孢哌酮／舒巴坦敏感性较好，而G菌对临床上用于胆道感染常用的第3代头孢菌素耐药率达55％～65％。结论两地区胆道感染常见菌略有不同，但两地区对G-杆菌经验用药可首选碳青霉烯类和头孢哌酮／舒巴坦。

Comparative Study on the Spectrum of Bile Culture Bacteria and Susceptibility Test between Guilin and Liuzhou in Guangxi Province

Objective To compare bile culture pathogens distribution and antimicrobial susceptibility of patients with biliary tract diseases in two adjacent areas, Guilin and Liuzhou in Guangxi province, in order to provide a basis for rational drug use in these two regions. Methods We retrospectively analyzed the clinical data of biliary tract disease patients undergoing bile aerobic bacteria culture, France bioMrrieux API identification and KB susceptibility test in two third-grade class-A hospitals between May 2011 and May 2013. Results The two hospitals in Guilin and Liuzhou had respectively 129 cases and 63 cases of bile bacteria culture and the positive rates were 44.18% and 53.96%, respectively. Sixty-five pathogen strains were cultured from patients in Guilin, and the top five were： 25 cases of Escherichia coli, 14 of Enterococcus faecalis, 9 of Klebsiella pneumoniae subsp, 6 of Enterococcus feces, and 4 of Pseudomonas aeruginosa. Forty-three pathogen strains were cultured from patients in Liuzhou, and the top five were： 19 cases of Escherichia coli, 8 ofPseudomonas aeruginosa, 5 ofEnterobacter aerogenes, 3 ofMorganella morganii, and 2 ofAcinetobacter baumannii. Enterobacteriaceae producing extended-spectrum beta-lactam enzymes increased year by year in both the two areas. The sensitivity of G＊ to vancomycin, ampicillin, and penicillin is good in the two regions, and G- bacteria had a good sensitivity to imipenem, amikacin, and cefoperazone/sulbactam. However, G- bacteria had a drug resistance rate up to 55%-65% to the third-generation cephalosporin which was commonly used for biliary tract infections. Coudusion The common bacteria causing biliary tract infections in the two areas are slightly different, and both the two regions can use carbapenems and cefoperazone/sulbactam as their first choice for Gbacilli.