胆道感染的胆汁细菌培养及对抗生素的敏感性研究

目的了解胆道感染患者胆汁中主要病原菌的分布及其对抗生素的敏感情况。方法回顾分析我院外科及上海交通大学附属瑞金医院普外科2006年75至2008年9月间收治的共128例胆道感染患者胆汁细菌培养检出的133株病原菌的分布及对抗生素的敏感情况。结果胆汁细菌培养总阳性率为92．97％（119例）。133株检出病原菌中革兰阴性菌96株（72．18％），革兰阳性菌32株（24．06％），真菌4株（3．01％）。培养阳性的主要致病菌包括大肠埃希菌（30．08％），肠球菌（20．30％），肺炎克雷伯菌（17．29％）和铜绿假单胞菌（8．27％）。革兰阴性菌对亚胺培南／西司他丁的敏感率为100％，其次是丁胺卡那霉素95．10％和哌拉西林／他唑巴坦85．16％；革兰阳性菌对万古霉素的敏感率为100％，哌拉西林／他唑巴坦91．41％，丁胺卡那霉素89．84％。结论哌拉西林／他唑巴坦和丁胺卡那霉素可作为治疗胆道感染的首选药物。

Isolation of Microorganisms from bile in biliary duct infection and their sensitivity to antibiotics

objective To identify the major pathogenic microorganisms in biliary duct infection and their sensitivity to antibiotics. Methods Retrospectively analyze data on 133 strains isolated from 128 biliary infection cases collected from Department of General Surgery, Shanghai Zhabei Area Shibei Hospital and General Surgical Department, Ruijin Hospital affiliated to Shanghai Jiaotong University between July, 2006 to September, 2008. Results Out of 128 biliary duct infection cases, 119 cases were positive for microorganism culture （92.97%） and 133 pathogenic strains were isolated, including 96 gram-negative strains （72.18%）, 32 gram-positive strains （24.06%） and 4 fungus strains （3.01%）. The pathogenic bacteria include Escheria Coli （30.08%）, Enterococcus （20.30%）, Klebsialla Pneumonia （17.29%） and Pseudomonsa aeruginosa （8.27%）. 100% gram-negative bacteria are sensitive to imipenem, 95.10% to the 1-n-（1-（-）-4- amino-2- hydroxybutyryl） kanamycin and 85.16% to Piperacillin/Tazobactam; Similarly, 100% gram-positive bacteria are sensitive to vancomycin, 91.41% to Piperacillin/Tazobactam, 89.84% to 1-n-（1-（-）-4-amino-2- hydroxybutyryl） kanamycin. Conclusions Overall, Piperacillin / Tazobactam are sensitive for both gram-negative and -positive bacteria and could be considered as the first line of medication in biliary duct infection.