摘要
目的通过非手术方式了解胆总管结石伴胆道感染患者胆汁中主要病原菌分布以及药敏性特点,为指导临床合理用药提供依据。方法对415例胆总管结石伴胆道感染患者行经内镜逆行胰胆管造影术,插管成功后抽吸胆汁进行细菌培养和药敏分析。结果 415份胆汁标本中有397份检出细菌,检出率为95.7%,其中革兰阴性菌317株,占73.9%;革兰阴性菌96株,占22.4%;真菌16株,占3.7%;革兰阴性杆菌耐药率最低的是亚胺培南,其次为哌拉西林/他唑巴坦、妥布霉素、头孢吡肟、阿米卡星,耐药率均<30.0%;肠球菌属对万古霉素的耐药率为0,对高浓度庆大霉素、高浓度链霉素、利福平、环丙沙星、利奈唑胺的耐药率均<15.0%。结论 415例胆总管结石伴胆道感染患者胆汁主要病原菌是大肠埃希菌、肠球菌属和肺炎克雷伯菌,肠球菌属明显增多,喹诺酮类耐药性增高。
OBJECTIVE To investigate the distribution of common pathogenic bacteria in the bile of 415 patients with choledocholithiasis complicated with biliary tract infections by non-operative style and analyze the characteristics of drug susceptibility so as to guide the reasonable clinical use of antibiotics.METHODS The ERCPs was performed for the 415 choledocholithiasis patients complicated with biliary tract infections,then the bacterial culture was carried out for the sampled bile after the successful catheterization,and the drug susceptibility testing was performed.RESULTS Totally 397 of 415 bile specimens were cultured positive for bacteria with the positive rate of 95.7%,there were 317（73.9%）strains of gram-negative bacteria,96（22.4%） strains of gram-positive bacteria,and 16（3.7%）strains of fungi.The drug susceptibility testing indicated that the drug resistance rate of the gram-negative bacilli to imipenem was the lowest,followed by the piperacillintazobactam,tobramycin,cefepime,and amikacin,with the drug resistance rate less than 30.0%;the drug resistance rate of the Enterococci to vancomycin was 0,and the drug resistance rates to intensified gentamicin,intensified streptomycin,rifampicin,ciprofloxacin,and linezolid were less than 15.0%.CONCLUSION The common pathogenic bacteria in the choledocholithiasis patients complicated with biliary tract infections are the Escherichia coli,Enterococci,and Klebsiella pneumoniae,and the constituent ratio of the Enterococciis increased,the drug resistance rate to quinolones is rising.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2013年第14期3529-3531,共3页
Chinese Journal of Nosocomiology
基金
山东省自然科学基金(ZR2009CL027)
山东大学科技局科技明星计划(20100118)
山东省医学科学院医学基金项目(201023)
关键词
胆总管结石
胆道感染
病原菌
Choledocholithiasis
Biliary tract infection
Pathogenic bacteria
