343例胆汁细菌培养结果及药敏试验分析
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摘要
目的通过对胆汁细菌培养,绘制胆道细菌谱,为临床抗菌药物使用提供病原学依据。方法对收治的行经内镜逆行胰胆管造影术(ERCP)患者343例,术中抽取胆汁行细菌培养,并对培养结果及药敏实验进行统计分析。结果获得胆汁标本343例,细菌培养阳性率100%,其中121例(35. 28%)患者胆汁中培养出2种或以上细菌,共获得470株细菌。培养细菌排列前4位的为大肠埃希菌(37. 02%)、屎肠球菌(13. 62%)、肺炎克雷伯菌(5. 96%)及铜绿假单胞菌(5. 53%),而厌氧菌培养阳性为0。对大肠埃希菌最为敏感的抗菌药物为亚胺培南(敏感率98. 3%)及阿米卡星(敏感率90. 2%),对屎肠球菌最为敏感的抗菌药物排序为万古霉素(敏感率96. 95%)、替考拉宁(敏感率89. 66%)及利奈唑脘(敏感率89. 66%)。结论胆道最常见细菌为大肠埃希菌,其次分别为屎肠球菌、肺炎克雷伯菌及铜绿假单胞菌,临床应结合胆汁培养及药敏试验结果合理选择抗菌药物。
Objective To describe the biliary bacteria spectrum through culturing the bacteria of the bile specimen so as to find theoretical basis for treating biliary tract infection. Methods Bile from 343 patients underwent ERCP( endoscopic retrograde cholangiopancreatography) were collected. Outcomes of bile bacterial culture and sensitivity test were analyzed. Results 343 bile specimen were collected,all of which were detected with bacteria. 470 bacterial strains were detected in the experiment,with two or more bacterial strains detected in 121 samples( 35. 28%). E. coli,Enterococcus faecium Klebsiella pneumonia and pseudomonas aeruginosa were the top four bacteria with 37. 02%,13. 62%,5. 96% and 5. 53% respectively. Anaerobes were all negative. Most sensitive antibiotics were imipenem( sensitive rate 98. 3%) and amikacin( sensitive rate 90. 2%) to E. coli. As to Enterococcus faecium,it were vancomycin( sensitive rate 96. 95%),teicoplanin( sensitive rate 89. 66%) and linezolid( sensitive rate 89. 66%). Conclusion E. coli is the most common bacterium in bile duct,followed by Enterococcus,Klebsiella pneumonia and Pseudomonas aeruginosa. Clinical antibiotics therapy should refer to the results of bile culture.
Objective To describe the biliary bacteria spectrum through culturing the bacteria of the bile specimen so as to find theoretical basis for treating biliary tract infection. Methods Bile from 343 patients underwent ERCP( endoscopic retrograde cholangiopancreatography) were collected. Outcomes of bile bacterial culture and sensitivity test were analyzed. Results 343 bile specimen were collected,all of which were detected with bacteria. 470 bacterial strains were detected in the experiment,with two or more bacterial strains detected in 121 samples( 35. 28%). E. coli,Enterococcus faecium Klebsiella pneumonia and pseudomonas aeruginosa were the top four bacteria with 37. 02%,13. 62%,5. 96% and 5. 53% respectively. Anaerobes were all negative. Most sensitive antibiotics were imipenem( sensitive rate 98. 3%) and amikacin( sensitive rate 90. 2%) to E. coli. As to Enterococcus faecium,it were vancomycin( sensitive rate 96. 95%),teicoplanin( sensitive rate 89. 66%) and linezolid( sensitive rate 89. 66%). Conclusion E. coli is the most common bacterium in bile duct,followed by Enterococcus,Klebsiella pneumonia and Pseudomonas aeruginosa. Clinical antibiotics therapy should refer to the results of bile culture.
引文
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[4]曹瑛,王建宏,叶文广,等.氟康唑治疗重症急性胰腺炎合并真菌感染的体会[J].宁夏医学杂志,2016,38(8):721-722.
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[6] Salvador VB,Lozada MC,Consunji RJ. Microbiology and antibiotic susceptibility of organisms in bile cultures from patients with and without cholangitis at an Asian academic medical center[J]. Surgical Infections,2011,12(2):105-111.
[7] Chang KK,Chang CL,Tai FT,et al. Empiric antibiotic choices for community-acquired biliary tract infections[J]. Adv Dig Med,2014,1(2):54-59.
[8] Herzog T,Belyaev O,Akkuzu R,et al. The impact of bile duct cultures on surgical site infections in pancreatic surgery[J]. Surgical Infections,2015,16(4):443-449.
[2] Kimura Y,Takada T,Strasberg SM,et al. TG13 current terminology,etiology,and epidemiology of acute cholangitis and cholecystitis[J]. Journal of Hepato Biliary Pancreatic Sciences,2013,20(1):8-23.
[3]杨勇,黄允宁,杨世杰,等.胆道感染的病原菌分布及药敏分析[J].中华普通外科学文献(电子版),2010,34(5):484-485.
[4]曹瑛,王建宏,叶文广,等.氟康唑治疗重症急性胰腺炎合并真菌感染的体会[J].宁夏医学杂志,2016,38(8):721-722.
[5] Kwon W,Jang JY,Kim EC,et al. Changing trend in bile microbiology and antibiotic susceptibilities:over 12 years of experience[J].Infection,2013,41(1):93-102.
[6] Salvador VB,Lozada MC,Consunji RJ. Microbiology and antibiotic susceptibility of organisms in bile cultures from patients with and without cholangitis at an Asian academic medical center[J]. Surgical Infections,2011,12(2):105-111.
[7] Chang KK,Chang CL,Tai FT,et al. Empiric antibiotic choices for community-acquired biliary tract infections[J]. Adv Dig Med,2014,1(2):54-59.
[8] Herzog T,Belyaev O,Akkuzu R,et al. The impact of bile duct cultures on surgical site infections in pancreatic surgery[J]. Surgical Infections,2015,16(4):443-449.