肝胆系统疾病合并胆道感染患者胆汁培养及耐药性分析
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摘要
目的分析肝胆系统疾病合并胆道感染患者胆汁培养及药物敏感性(药敏)试验结果,为临床使用抗菌药物提供依据。方法本前瞻性研究对象为2015年1月至2016年8月中山大学附属中山医院136例肝胆系统疾病合并胆道感染患者。其中男83例,女53例,平均年龄(43±10)岁。患者均签署知情同意书,符合医学伦理学规定。收集所有患者的胆汁进行细菌、真菌培养,并行耐药性分析。结果共分离、培养出136株病原菌,其中革兰阴性菌占69.8%,革兰阳性菌占28.7%,真菌占1.5%。其中前5位分别是大肠埃希菌(35.3%)、肺炎克雷伯菌(14.0%)、粪肠球菌(12.5%)、屎肠球菌(9.6%)及铜绿假单胞菌(8.0%)。革兰阴性菌对碳青霉烯类药物耐药率较低;革兰阳性菌对万古霉素、利奈唑胺、替加环素表现出高敏感性,而对红霉素、克林霉素敏感性较低;白假丝酵母菌对伊曲康唑、氟康唑表现出较高的敏感性。结论胆道感染中革兰阴性菌仍占主要地位,然而革兰阳性菌比例明显升高,临床治疗应依据药敏试验结果合理选用抗菌药物,以降低病原菌的耐药性,提高治愈率。
Objective To analyze the results of the bile culture and drug sensitivity test in patients with hepatobiliary disease complicated with biliary tract infection to provide reference for clinical use of antibiotics. Methods One hundred and thirty-six patients who were diagnosed with hepatobiliary disease complicated with biliary tract infection in Zhongshan Hospital of Sun Yat-sen University from January 2015 to August 2016 were enrolled in this prospective study. There were 83 males and 53 females with a mean age of(43±10) years old. The informed consents of all patients were obtained and the local ethical committee approval was received. The bile specimens from all patients were collected for bacterial and fungal culture and drug resistance analysis was performed. Results A total of 136 pathogens were isolated and cultured, including 69.8% of gram-negative pathogens, 28.7% of gram-positive pathogens and 1.5% of fungi. The most prevalent five pathogens were Escherichia coli(35.3%), Klebsiella pneumonia(14.0%), Enterococcus faecalis(12.5%), Enteroccocus faecium(9.6%) and Pseudomonas aeruginosaranked(8.0%). Low resistance to carbapenems was observed in gram-negative pathogens. Gram-positive pathogens revealed highly sensitive to vancomycin, linezolid and tigecycline, whereas less sensitive to erythrocin and clindamycin. Candidaalbicans revealed highly sensitive to itraconazole and fluconazole. Conclusions Gram-negative pathogens are the dominant pathogens in biliary tract infection, but the proportion of gram-positive pathogens significantly increases. The antibiotic drugs should be selected reasonably according to the results of drug sensitivity test in the clinical teatment to reduce the drug resistance of pathogens and raise the cure rate.
Objective To analyze the results of the bile culture and drug sensitivity test in patients with hepatobiliary disease complicated with biliary tract infection to provide reference for clinical use of antibiotics. Methods One hundred and thirty-six patients who were diagnosed with hepatobiliary disease complicated with biliary tract infection in Zhongshan Hospital of Sun Yat-sen University from January 2015 to August 2016 were enrolled in this prospective study. There were 83 males and 53 females with a mean age of(43±10) years old. The informed consents of all patients were obtained and the local ethical committee approval was received. The bile specimens from all patients were collected for bacterial and fungal culture and drug resistance analysis was performed. Results A total of 136 pathogens were isolated and cultured, including 69.8% of gram-negative pathogens, 28.7% of gram-positive pathogens and 1.5% of fungi. The most prevalent five pathogens were Escherichia coli(35.3%), Klebsiella pneumonia(14.0%), Enterococcus faecalis(12.5%), Enteroccocus faecium(9.6%) and Pseudomonas aeruginosaranked(8.0%). Low resistance to carbapenems was observed in gram-negative pathogens. Gram-positive pathogens revealed highly sensitive to vancomycin, linezolid and tigecycline, whereas less sensitive to erythrocin and clindamycin. Candidaalbicans revealed highly sensitive to itraconazole and fluconazole. Conclusions Gram-negative pathogens are the dominant pathogens in biliary tract infection, but the proportion of gram-positive pathogens significantly increases. The antibiotic drugs should be selected reasonably according to the results of drug sensitivity test in the clinical teatment to reduce the drug resistance of pathogens and raise the cure rate.
引文
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[12]吴晓春,侯章梅,成燕,等.2011~2013年某院胆道感染病原菌与细菌耐药性分析[J].重庆医学,2015(30):4207-4209,4212.
[13]段群欢.胆道手术患者细菌感染及抗菌药物敏感性分析[J].海南医学,2012,23(16):124-126.
[14]薛金方,邓海云,黄涌泉.铜绿假单胞菌耐药性分析[J].中国实用医药,2016,11(14):172-173.
[15]王燕萍,冯翠,陈晓丹,等.鲍曼不动杆菌流行病学分布及耐药性分析[J].国际检验医学杂志,2016,37(9):1259-1261.
[16]黎利娟,傅斌生,周密,等.器官移植患者鲍曼不动杆菌药敏情况分析[J/CD].中华肝脏外科手术学电子杂志,2015,4(6):360-362.
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[19]孟小斌,张国雄,古汉福.胆道感染病原菌分布及耐药性分析[J].今日药学,2014,24(4):299-301.
[20]黎敏,邱喜辽,王俊霁,等.4925株医院感染细菌分布及耐药性分析[J].重庆医学,2010,39(24):3360-3362,3364.
[21]姜艳梅,刘新元,王晶,等.5年胆道感染患者胆汁中病原菌的分布及耐药性分析[J].中华医院感染学杂志,2011,21(3):596-598.
[22]林宗梅,綦怀纲,余丹,等.胆结石患者胆道感染病原菌分布及药敏分析[J].中华医院感染学杂志,2015(8):1747-1749.
[23]危华玲,罗淑萍,杨青.胆道感染的病原菌及药物敏感性研究[J].中华医院感染学杂志,2013,23(17):4303-4304,4307.
[2]Zong Z.Biliary tract infection or colonization with Elizabethkingia meningoseptica after endoscopic procedures involving the biliary tract[J].Intern Med,2015,54(1):11-15.
[3]杨永,杨连招,莫新少.胆石症并胆道感染患者常见菌群及其药敏分析、耐药情况[J].广西医科大学学报,2011,28(6):975-977.
[4]瞿渝佳,张秀瑜,王云英.2012年某医院临床病原菌分布及耐药监测性分析[J].重庆医学,2013,42(21):2514-2516.
[5]孙斌,郭源,李坤.胆总管结石伴胆道感染患者胆汁病原菌分布与药敏性分析[J].中华医院感染学杂志,2013,23(14):3529-3531.
[6]卢宝卫,刘墅竹,孙菊芬.胆道疾病患者343份胆汁细菌培养与药敏分析[J].微生物学杂志,2010,30(6):101-103.
[7]叶应妩.全国临床检验操作规程[M].3版.南京:东南大学出版社,2006.
[8]Moazeni-Bistgani M,Imani R.Bile bacteria of patients with cholelithiasis and their antibiogram[J].Acta Med Iran,2013,51(11):779-783.
[9]颜云宙,陈捷,楼亚玲.125例胆道疾病患者胆汁细菌培养及药敏鉴定分析[J].中国微生态学杂志,2015,27(9):1066-1068,1072.
[10]赵声远,肖淑珍,韩立中,等.住院患者血流感染分离病原体及其耐药性[J].中国感染控制杂志,2014,13(5):266-270.
[11]戴美洁,周铁丽,王赛芳,等.老年患者血培养病原菌分布及耐药性调查[J].中国微生态学杂志,2007,19(3):295-297.
[12]吴晓春,侯章梅,成燕,等.2011~2013年某院胆道感染病原菌与细菌耐药性分析[J].重庆医学,2015(30):4207-4209,4212.
[13]段群欢.胆道手术患者细菌感染及抗菌药物敏感性分析[J].海南医学,2012,23(16):124-126.
[14]薛金方,邓海云,黄涌泉.铜绿假单胞菌耐药性分析[J].中国实用医药,2016,11(14):172-173.
[15]王燕萍,冯翠,陈晓丹,等.鲍曼不动杆菌流行病学分布及耐药性分析[J].国际检验医学杂志,2016,37(9):1259-1261.
[16]黎利娟,傅斌生,周密,等.器官移植患者鲍曼不动杆菌药敏情况分析[J/CD].中华肝脏外科手术学电子杂志,2015,4(6):360-362.
[17]Yuan Z,Tam VH.Polymyxin B:a new strategy for multidrugresistant Gram-negative organisms[J].Expert Opin Investig Drugs,2008,17(5):661-668.
[18]赵欣,魏琳琳,董青.胆石症患者胆道感染的病原菌分布与耐药性分析[J].中华医院感染学杂志,2015(9):1989-1990,1993.
[19]孟小斌,张国雄,古汉福.胆道感染病原菌分布及耐药性分析[J].今日药学,2014,24(4):299-301.
[20]黎敏,邱喜辽,王俊霁,等.4925株医院感染细菌分布及耐药性分析[J].重庆医学,2010,39(24):3360-3362,3364.
[21]姜艳梅,刘新元,王晶,等.5年胆道感染患者胆汁中病原菌的分布及耐药性分析[J].中华医院感染学杂志,2011,21(3):596-598.
[22]林宗梅,綦怀纲,余丹,等.胆结石患者胆道感染病原菌分布及药敏分析[J].中华医院感染学杂志,2015(8):1747-1749.
[23]危华玲,罗淑萍,杨青.胆道感染的病原菌及药物敏感性研究[J].中华医院感染学杂志,2013,23(17):4303-4304,4307.