胆道感染患者196例胆道细菌培养及耐药分析

目的：了解胆道感染患者胆汁中主要致病菌的分布及其抗生素敏感情况。方法对福建医科大学附属龙岩第一医院2008年1月至2012年1月间收治的196例胆道感染患者进行胆汁细菌培养和抗生素敏感情况分析。结果从164例患者的胆汁中共分离171株需氧菌，总阳性率为83.67%（164/196）。171株中革兰阴性菌112株，占65.50%；革兰阳性菌59株，占34.50%。革兰阴性菌的主要致病菌包括大肠埃希菌（35.00%）、肠球菌（27.49%）、肺炎克雷白菌（10.00%）和铜绿假单胞菌（4.00%）。革兰阴性菌对碳青酶烯类药物、阿米卡星、头孢哌酮/舒巴坦仍比较敏感，耐药率分别为低于1.8%、3.5%、11.1%；革兰阳性菌对氨苄西林、阿莫西林/克拉维酸钾的耐药率分别为低于6.1%、0。耐万古霉素的肠球菌（VRE）检出率依然较低，粪肠球菌、屎肠球菌对万古霉素的耐药率分别为2.6%、0。结论头孢哌酮/舒巴坦、阿米卡星可作为治疗胆道感染的首选用药。当革兰阳性菌如肠球菌或耐甲氧西林凝固酶阴性葡萄球菌为致病菌时，应根据胆汁培养结果选用窄谱抗生素。

Analysis of bacterial distribution and drug resistance in 196 patients with biliary tract infection

Objective To find out the main pathogenic bacteria distribution and sensitivity to antibiotics in the bile of patients with biliary tract infection. Methods The distribution and antibiotic sensitivity of 196 patients with biliary tract infection in our hospital from January 2008 to January 2012 were reviewed and analyzed. Results From 171 strains of pathogenic bacteria of 164 patients, the total positive culture rate was 83.67%（164/196）. There were 112 gram-negative bacteria （65.50%） and 59 gram-positive bacteria （34.50%）. The positive pathogenic bacteria include e.coli （35.00%）, enterococcus （27.49%）, white fungus （10.00%）, klebsiella pneumoniae and pseudomonas aeruginosa （4.00%）. Gram-negative bacteria were still sensitive to carbon blue enzyme alkenes medicine, amikacin, and cefoperazone/sulbactam, with drug resistance rate less than 1.8%, 3.5%and 11.1%. Gram-positive bacteria were still sensitive to ampicillin, amoxicillin/clavulanic acid potassium, with drug resistance rate less than 6.1%, 0. Conclusions Gram-negative bacteria are the main pathogenic bacteria in the bile of patients with biliary tract infection. Amikacin, cefoperazone/sulbactam may be the first choice antibiotics. Narrow-spectrum antibiotics are better for gram-positive bacteria, such as enterococcus and methicillin-resistant staphylococcus episermidis.