胆石症胆汁细菌培养及抗生素应用对策

目的 探讨胆石症患者胆汁感染时的细菌学特点和药敏情况，为选用价廉、有效的抗生素提供依据。方法 连续对2000年3月～2001年10月我院经手术治疗胆石症420例术中取胆汁进行需氧菌培养及药敏试验。结果 胆汁培养阳性118例，阳性率28．1％，培养出122株细菌，以大肠杆菌、克雷伯氏菌为主，其次是沙雷氏菌、肠球菌及金黄色葡萄球菌。年龄≥60岁者，阳性率较高达48．2％．胆总管结石患者比单纯胆囊结石阳性率高，急性期比非急性期高。G^ 菌对舒胺新、头孢唑啉钠、丁胺卡那霉素较敏感；G^-菌对舒胺新、三代头孢、喹喏酮类及丁胺那霉素较敏感。结论 胆石症患者胆汁细菌学培养阳性率与胆道感染程度、病种及年龄有关，抗生素首选舒胺新或丁胺卡那霉素 甲硝唑，次选头孢唑啉及喹诺酮类 甲硝唑。

Biliary bacteriology in cholelithiasis and relevant antibiotics application

Objective To explore the characteristics and drug sensitive of billiary bacteriology for the purpose of effective antibiotics application. Methods Culture and drug sensitive test of aerobic bacteria of bile specimens in 420 cases cholelithiasis which underwent surgical treatment from 2000 to 2001 in our hospital were done. Results 118 cases were positive in biliary bacterial culture with a positive rate of 28.1%. Among these cases 122 kinds of bacterial lines were found. Predominantly with Escherichia coli and Klebsiclla pneumonias, secondly with Serratia, Enterococcus and Staphylococcus aureus. For patients over 60 in age, positive rat was 48.2%, much higher than those age below 60. Positive rat of biliary bacteria in patients with common bile duct calculi was higher than patients with gallbladder stones. For acute cases positive rate was much higher than non-acute cases. Drug sensitive test showed that gram-positive bacteria were more sensitive to amoxycillin plus sulbactam, cefazollin, and amikacin, gram-negative bacteria were sensitive to amoxycillin plus sulbactam, third generation cephalosporins, quinolones, and amikacin. Conclusions The positive rate of biliary bacterial culture in cholelithiasis is related to biliary infective extent, bile stone position and age. The first choice of antibiotics application is amoxycillin plus sulbactam, or amikacin and metronidazole, the second choice is cefazollin or quinlones, and metronidazole.