鼻胆管胆汁细菌培养及抗生素敏感性分析

目的:分析ERCP鼻胆管胆汁的微生物检测及细菌对抗生素的敏感性。方法:对2012年1月至2013年8月的112例病人ERCP后临床无感染征象时行鼻胆管胆汁细菌培养和抗生素敏感试验。结果:在123次鼻胆管胆汁微生物培养中52次检测结果阳性,阳性率为42.3%,其中细菌10种,真菌3种。所有胆汁培养共检出细菌58株,其中革兰阴性菌6种42株,革兰阳性菌4种11株,真菌3种5株。胆汁革兰阴性菌对碳青霉烯类抗生素(亚胺培南、厄他培南)和氨基糖苷类抗生素(阿米卡星、庆大霉素)的敏感性最高,对头孢曲松、头孢他啶等第三代头孢菌素和左氧氟沙星、哌拉西林/三唑巴坦中度敏感,对环丙沙星、氨苄西林/舒巴坦等抗生素较不敏感,对头孢唑林均不敏感。革兰阳性菌对万古霉素仍较敏感,对喹努普汀/达福普汀、利奈唑胺、替加环素高度敏感,但对苯唑西林等青霉素和克林霉素、红霉素等敏感性不高。结论:临床无感染症状病人的鼻胆管胆汁具有较高的细菌感染率。本研究对于ERCP后胆道感染复发病人早期使用抗生素,控制病情进展提供了参考。

Bile culture from nasobiliary drainage and antibiotic sensitivity

Objective To study the biliary infection with bile culture from nasobiliary drainage and the antibiotic sensitivity of germs in surgical patients without symptoms of infection after endoscopic retrograde cholangiopancreatography （ERCP）. Methods Bile culture was performed including the detection of antibiotic sensitivity of bacteria in 112 patients with nasobiliary drainage after ERCP and without symptoms of infection from January 2012 to August 2013. Results There were 52 （42.3%） samples positive from microbiological culture out of 123 nasobiliary drainage with 10 species of bacteria and 3 species of fungi. Totally 58 strains of microorganism were detected including 6 species of Gram-negative bacteria （42 strains） and 4 species of Gram-positive bacteria （11 strains） and 3 species of fungi （5 strains）. Gram-negative bacteria in bile were most sensitive to carbapenems （imipenem, ertapenem） and aminoglycosides （amikacin, gentamicin）, moderately sensitive to third generation cephalosporins （ceftriaxone, ceftazidime）, levofloxacin and piperacillin/tazobactam, and less sensitive to ciprofloxacin and ampicillin/sulbactam. They were all not sensitive to cefazolin,. Gram-positive bacteria re- mained high sensitivity to vancomycin. They were almost high sensitive to quinupristin/dalfopristin, linezolid and tigecy- cline, but not sensitive to penicillin such as oxacillin, clindamycin, erythromycin and others. Conclusions The higher rate of bacteria was detected in nasobiliary drainage of patients who had no clinical symptoms of infection. The basis on which early empiric antibiotic therapy are given to control infection progression for patients with recurrent biliary infection after ERCP was provided in this study.