735株胆汁培养细菌菌株构成及耐药性分析

目的了解大庆油田总医院胆汁培养细菌菌株构成及耐药性变化,为临床合理使用抗菌药物提供依据。方法对2014年4月~2018年3月大庆油田总医院胆道感染患者分离的735株细菌及其药敏试验结果进行回顾性分析。结果在735株细菌中,分离出革兰阴性菌552株(75.1%),革兰阳性菌183株(24.9%),其中大肠埃希菌(235株,32.0%)、肺炎克雷伯菌(111株,15.1%)和屎肠球菌(72株,9.8%)分列前三位。革兰阴性菌对碳青霉烯类、氨基糖苷类及含β-内酰胺酶抑制剂的药物敏感;革兰阳性菌对糖肽类、噁唑烷酮类、链阳菌素类药物敏感。大肠埃希菌ESBLs的携带率呈逐年下降趋势,肺炎克雷伯菌ESBLs的携带率逐年上升;碳青霉烯类耐药肠杆菌开始出现,尚未发现万古霉素耐药的肠球菌。结论胆道感染细菌的菌种构成及耐药情况均在不断演变中,临床医生应做胆汁培养来指导临床合理用药,以减少耐药菌株的产生。

Analysis of the Composition and Drug Resistance of 735 Strains of Bile Cultured Bacteria

Objective To understand the composition and drug resistance of bacterial strains in bile culture in Daqing Oilfield General Hospital, and to provide evidence for clinical rational use of antimicrobial agents. Methods A retrospective analysis was performed on 735 strains of bacteria isolated from patients with biliary infection between April 2014 and March 2018. Results Of the 735 strains, 552 strains of Gram-negative bacteria (75.1%) and 183 strains of Gram-positive bacteria (24.9%) were isolated, including Escherichia coli (235 strains, 32.0%) and Klebsiella pneumoniae ( 111 strains, 15.1%) and Enterococcus faecium (72 strains, 9.8%) were ranked in the top three. Gramnegative bacteria are mainly sensitive to carbapenems, aminoglycosides and drugs containing β-lactamase inhibitors;Gram-positive bacteria are mainly for glycopeptides, oxazolidinones, streptomycins sensitive. The carrying rate of ESBLs in Escherichia coli in this region is decreasing year by year, and the carrying rate of cephalosporinase is increasing year by year. The carrying rate of Klebsiella pneumoniae ESBLs is increasing year by year;carbapenemase begins to appear in this area. Vancomycin-resistant enterococci have not been found. Conclusion The composition and drug resistance of bacteria in biliary tract infections are constantly evolving. Clinically, bile culture should be used to guide clinical rational drug use to reduce the production of drug-resistant strains.