胆道感染患者中检出细菌分布及其耐药性分析

目的了解引起胆道感染的细菌分布及其耐药情况，指导临床合理用药。方法用常规的方法对胆道感染患者胆汁进行细菌培养、分离，API进行鉴定，按NCCLS标准用K—B法进行药敏检测。用Whonet5．0软件进行数据分析。结果从胆汁中分离出117株需氧茵，其中革兰阴性杆菌（G—B）占73．5％（86／117），革兰阳性球菌（G^＋ C）占26．5％（31／117）。在G—B中，发酵糖类的细菌占74．4％（64／86），主要有大肠埃希菌占59．3％（38／64）、克雷伯菌占18．1％（12／64）、肠杆菌占14．1％、枸橡酸杆菌占7．8％，其中产超广谱β-内酰胺酶的发生率为7．6％（2／50）；不发酵糖类的细菌占25．6％（22／86），包括绿脓假单胞菌占77．3％（17／22）、不动杆菌9．1％、嗜麦芽窄食黄单胞菌占13．65。G—B中发酵糖类的细菌的耐药率除泰能为0．0％、阿米卡星9．3％、头孢泊肟13．6％、萘替米星14．1％、头孢他啶23．4％、头孢哌酮23．4％、替卡西林／克拉维酸28．1％、头孢哌酮／舒巴坦25．0％以外，其余均在30．0％以上；不发酵糖类的细菌（除嗜麦窄食黄单胞菌外）的耐药率除泰能为13．6％、头孢他啶13．6％、头孢泊肟13．6％、萘替米星22．7％、哌拉西林／他唑巴坦27．3％，其余均在30．0％以上。在G^＋ C中葡萄球菌占16．1％（5／31），肠球菌占83．9％（26／31），所有葡萄球菌对万古霉素、苯唑西林均敏感，肠球菌高耐庆大霉素占23．1％，对万古霉素耐药率为11．5％（全部表现为中介）。结论引起胆道感染的主要病原菌有大肠埃希菌和肠球菌，泰能、万古霉素分别对G—B、G^＋ C显示较好的体外抗菌活性。

Determination of drug resistance of bacteria in bile of patients and control measures

Objective To understand resistance of bacteria in bile to antibiotics and provide reference for clinial treatment. Methods All species were isolated with conventional method and identified by API , the susceptibility were detected by K- B method （refer to the standard of NCCLS 2002）, the data were statistically analysed. Results In 117 isolated stains , Gram negative bacilli accounted for 73.5% （86/117）, gram positive cocci （G＋ C） 26.5% （31/117）. In G B , the glucose fermenter species occupied 74.4% （64/86）, including Escherichia. Coli 59.3% （38/64）, Klebsiella 8.8% （12/64） （ESBLs7.6%）, Enterobacter 54 % （9/64）, Citrobacter 7.8 % （5/64）. their resistant rates to 21 antibiotics were over 30.30 % Their resistant rates to Imipenem, Amikacin, Cefepime , Netilmicin, Ceftazidime, Cefoperazone, Ticarcillin/Clavulanic and Cefoperazone/Sulbactam were0.0%, 9.3%, 52.5%, 54.1%, 23.4%, 23.4%, 28.1% and25.0% . There were glucose infermenter enter species （25.6%） including Pseudomonaz aeruginosa , Xanthomonas sp and Acimetbacter with the incidence of 77.3% （ 17/22）, 9.0% （2/22） and 13.6% （3/22）. The resistant rates of the bacteria （excluded Xanthomonaz sp ）to 12 antibiotics were over 30.0% except Impenem, Ceftazidime, Cefepime, Netilmicin and Piperacillin/tazobactam（ with resistant rates of 13.6%, 13.6%, 13.6%, 22.7% and 27.3% ）. nG＋ C, Staphylococcus accounted for 16.1% （5/35）, Enterococcus 83.9% （26/35）. All Stapylococcus weree susceptible to Oxacillin and Vancomycin; the resistant rate of Enterococcus to Gentamicin- High is 23.1%, and No Enterococcus was resistance to Vancomycin with a resistance rate of 11.5% . Conclusion The main species from bile with infection is Escherichia. col, Pseudomonas aeruginosa and Enterococcus . lmpenem is effective to G - B and Vancomycin is effective to G^＋ C.