胆道感染病原菌分布及耐药性分析

目的 研究和探讨胆道感染病原菌的分布及其耐药性,为临床使用抗菌药物提供依据.方法 收集医院2007年1月-2010年12月胆道感染患者的362份胆汁进行细菌培养,对分离病原菌进行鉴定及药敏试验,整理分析检测结果.结果 362份胆汁标本共检测到231株病原菌,阳性率为63.3％；革兰阴性杆菌占68.8％,革兰阳性球菌占26.0％,真菌占2.2％；引起胆道感染的常见病原菌有大肠埃希菌占29.0％、粪肠球菌占15.2％、肺炎克雷伯菌占10.8％、阴沟肠杆菌占9.5％、鲍氏不动杆菌占7.8％；革兰阴性杆菌对亚胺培南和哌拉西林/他唑巴坦耐药率低,分别为0.6％、6.9％,而对氨苄西林的耐药率为94.3％、头孢唑林为71.7％、磺胺甲噁唑/甲氧苄啶为51.6％；革兰阳性球菌对万占霉素的耐药率为0,其次呋喃妥因为1.7％、利条唑胺为3.3％,真菌药物敏感性较好.结论 胆道感染仍以革兰阴性杆菌为主,病原菌谱构成有所变迁,不动杆菌属和肠杆菌属增多,病原菌耐药性增强,需加强对病原菌的检测及耐药性分析,有针对性合理使用抗菌药物.

Distribution of pathogens causing biliary tract infections and drug resistance

OBJECTIVE To study and explore the distribution of pathogens causing biliary tract infections and drug resistance so as to provide basis for the clinical use of antibiotics.METHODS From Jan 2007 to Dec 2010,a total of 362 patients with biliary tract infections were collected for bacterial culture of bile,the isolation and identification of the pathogens and drug susceptibility testing were performed,the test results were analyzed.RESULTS A total of 231 strains of pathogens were isolated from 362 bile samples with the positive rate of 63.3%;gram-negative bacilli accounted for 68.8%,gram-positive cocci accounted for 26.0%,fungi accounted for 2.2%;the common pathogens causing biliary tract infections were Escherichia coli(29.0%),Enterococcus faecalis(15.2%),Klebsiella pneumoniae(10.8%),Enterobacter cloacae(9.5%),Acinetobacter baumannii(7.8%);drug susceptibility testing results showed that the drug resistance rates of gram-negative bacilli to imipenem,piperacillin/tazobactam,ampicillin,cefazolin,and sulfamethoxazole/trimethoprim were 0.6%,6.9%.94.3%,71.7%,and 51.6%,respectively;the resistance rates of gram-positive cocci to vancomycin,nitrofurantoin,and linezolid were 0,1.7%,and 3.3%;drug susceptibility of the fungi was good.CONCLUSION Gram-negative bacilli remain the pathogens causing baliary tract infections,the spectrum of the pathogens always changes,Acinetobacter and Enterobacter increase,and the drug resistance of the pathogens has been increased,it is necessary to strengthen the detection of the pathogens and the analysis of the drug resistance so as to reasonably use antibiotics.