手术方式采集的197份胆汁标本需氧菌培养及药敏分析

目的了解某院胆道感染患者胆汁中常见病原菌及其耐药变化趋势,为指导临床正确选用抗菌药物提供依据。方法对该院2010年1月—2011年12月间197例手术中直接穿刺采集的胆汁标本进行需氧培养,并做细菌鉴定和药敏试验。结果 197份胆汁标本中,130份培养阳性,阳性率为65.99%;共分离151株需氧菌,其中21份标本为需氧菌混合感染。分离革兰阴性(G-)杆菌114株(75.50%),革兰阳性(G+)球菌36株(23.84%),真菌1株(0.66%)。病原菌居前6位者依次为大肠埃希菌(48.34%)、屎肠球菌(10.59%)、阴沟肠杆菌(6.62%)、粪肠球菌(5.96%)、肺炎克雷伯菌(5.96%)、铜绿假单胞菌(4.64%)。大肠埃希菌、阴沟肠杆菌、肺炎克雷伯菌对碳青霉烯类药物(亚胺培南、美罗培南)敏感率达100.00%;大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌对哌拉西林/他唑巴坦和阿米卡星敏感性高(敏感率77.78%～100.00%);肠球菌属细菌对替加环素、利奈唑胺敏感率为100.00%,粪肠球菌对万古霉素敏感率为100.00%,1株屎肠球菌对万古霉素耐药。G-杆菌对青霉素类、头孢菌素类、喹诺酮类抗菌药物敏感性普遍下降。结论胆道感染细菌以肠杆菌科细菌为主,其次为肠球菌属;临床医生在经验用药的同时,应尽早做胆汁培养和药敏检测,根据药敏试验结果合理用药。

Aerobic culture of 197 intra operatively collected bile specimens and antimicrobial susceptibility of bacteria

Objective To realize the isolation and drug resistance of major pathogens from bile of patients with biliary tract infection, so as to provide reference for rational use of antimicrobial agents.MethodsBile specimens collected from 197 operated patients in a hospital from January 2010 to December 2011were performed aerobic culture, bacteria were identified and performed antimicrobial susceptibility testing. ResultsOf 197 bile specimens, 130 （65.99%） were positive culture; 151 aerobic isolates were obtained, 21 specimens isolated mixed bacteria. The isolated pathogens included 114（75.50%） isolates of gram negative bacilli, 36 （23.84%） of gram positive cocci, and 1 （0.66%） of fungus. The top 6 pathogens were Escherichia coli（48.34%）, Enterococcus faecium（10.59%）, Enterobacter cloacae（6.62%）, Enterococcus faecalis（5.96%）, Klebsiella pneumoniae（5.96%）, and Pseudomonas aeruginosa（4.64%）. Sensitive rates of Escherichia coli, Enterobacter cloacae and Klebsiella pneumoniae to carbapemem （imipenem, meropenem） were 100.00%; Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa to piperacillin/tazobactam and amikacin were 77.78%-100.00%; Enterococcus spp. to tigecycline and linezolid were 100.00%, all Enterococcus faecalis to vancomycin were 100.00%, 1 Enterococcus faecium isolate was resistant to vancomycin. Sensitive rates of gram negative bacilli to penicillins, cephalosporins, and quinolones decreased.ConclusionBiliary tract infection is mainly caused by Enterobacteriaceae and Enterococcus spp., bile culture and antimicrobial susceptibility testing of pathogens should be performed as early as possible, clinicians should choose antimicrobial agents according to antimicrobial susceptibility testing results.