胆石症并胆道感染患者胆汁与血细菌培养比较及药敏分析

目的探讨胆石症并胆道感染患者胆汁与血中细菌分布、细菌培养阳性率及二者关系,并探讨菌群对抗生素的敏感性,以指导临床用药。方法对浙江省象山县第一人民医院2003-01~2004-05胆总管结石并胆道感染患者120例通过ERCP胆管深插管抽取胆汁进行细菌培养加药敏试验,同时取40例进行血培养。结果120例胆汁培养67例检出细菌,阳性率为55.8%。40例血培养10例检出细菌,阳性率为25.0%。均主要由G-菌中的大肠埃希菌属、克雷伯杆菌属和肠杆菌属构成。10种抗生素敏感谱中,亚胺培南、美洛匹宁、阿米卡星、庆大霉素等抗菌效果优于氨苄青霉素、替卡西林、头孢噻吩、头孢西丁、头孢呋辛等(P<0.05)。结论胆石症并胆道感染患者胆汁及血中细菌分布均以G-菌为主,且在菌属构成上差异无显著性。但胆汁中细菌阳性率明显高于血培养中细菌阳性率(P<0.01)。治疗上宜据药敏试验主要针对G-杆菌应用敏感抗生素。

Comparison between bile and blood bacteria culture and analysis of medicine sensitivity of bacteria in patients with cholelithiasis along with biliary infection

Objective Explore the bacteria distribution in both bile and blood culture and their bacteria positive ratio and their relations.Methods Biles of 120 cases and the blood samples of 40 of all patients with cholelithiasis along with biliary infection were collected and cultured respectively during endoscopic retrograde cholangiopancreatography(ERCP) by deep cannulation and suking out bile through the catheter.Results Bactetia were found in 67 of 120 patients and they consisted of 11 kinds of aerobes,the bile bacteria positive ratio of the 120 bile samples being 55.8%.10 kinds of bacteria were found in the blood samples of 10 in 40 patients by culturing,the bile bacteria positive ratio of the 10 blood samples being 25%.Conclusion The bile bacteria positive ratio of the bile samples is significiantly higher than blood samples,but microbial populations of them mainly consist of germ-negative bacillus.There are no difference significiant in bacteria composition.So we shoud apply antibiotics,which germ-negative bacillus are sensitive to according to bacteria susceptibility test during clinical treatments.