中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2009年
7期
527-529
,共3页
胆道疾病%胆汁%感染%抗药性,细菌
膽道疾病%膽汁%感染%抗藥性,細菌
담도질병%담즙%감염%항약성,세균
Biliary tract diseases%Bile%Infection%Drug resistance,bacterium
目的 分析胆道疾病患者胆汁致病菌的分布特点及耐药情况,以便合理选择抗生素.方法 抽取2007年6月至2008年3月在上海交通大学医学院附属仁济医院普外科行胆道手术的195例患者的术中胆汁,并选取24名健康人作为对照,进行细菌培养及药物敏感试验.结果 195例胆道疾病患者胆汁培养阳性率为22.6%(44/195),其中混合感染率为25.0%(11/44).培养菌株55株,菌种16种,其中G-菌占61.8%(34/55),C+菌占34.6%(19/55),真菌占3.6%(2/55).主要致病菌为大肠杆菌(27.3%)、阴沟肠杆菌(12.7%)、粪肠球菌(12.7%)、屎肠球菌(10.9%).24名健康人正常胆汁培养阳性率为4.2%(1/24),为大肠杆菌.药物敏感实验结果显示:G-菌对美洛培南总耐药率最低(2.8%),其次为亚胺培南(5.6%)、头孢哌酮/舒巴坦(22.8%)、阿米卡星(28.7%).对青霉素类、喹讲酮类、部分三代头孢菌素类等抗生素耐药率较高(>50.0%).G+菌对万古霉素、替考拉宁总耐约率为0.对青霉素类、喹诺酮类、克林霉素等抗生素耐药率较高(>40.0%).结论 (1)该院胆道感染以G-菌为主,主要致病菌为大肠杆菌,肠球菌有上升趋势.细菌混合感染多见于急性感染患者.(2)治疗胆道感染首选对大肠杆菌耐药率低的广谱抗生素.头孢他啶、环丙沙星可用于胆道轻度感染,中重度感染首选头孢哌酮/舒巴坦或阿米卡星,亚胺培南、万古霉素可作为临床二线用药治疗其他药物治疗无效的感染.
目的 分析膽道疾病患者膽汁緻病菌的分佈特點及耐藥情況,以便閤理選擇抗生素.方法 抽取2007年6月至2008年3月在上海交通大學醫學院附屬仁濟醫院普外科行膽道手術的195例患者的術中膽汁,併選取24名健康人作為對照,進行細菌培養及藥物敏感試驗.結果 195例膽道疾病患者膽汁培養暘性率為22.6%(44/195),其中混閤感染率為25.0%(11/44).培養菌株55株,菌種16種,其中G-菌佔61.8%(34/55),C+菌佔34.6%(19/55),真菌佔3.6%(2/55).主要緻病菌為大腸桿菌(27.3%)、陰溝腸桿菌(12.7%)、糞腸毬菌(12.7%)、屎腸毬菌(10.9%).24名健康人正常膽汁培養暘性率為4.2%(1/24),為大腸桿菌.藥物敏感實驗結果顯示:G-菌對美洛培南總耐藥率最低(2.8%),其次為亞胺培南(5.6%)、頭孢哌酮/舒巴坦(22.8%)、阿米卡星(28.7%).對青黴素類、喹講酮類、部分三代頭孢菌素類等抗生素耐藥率較高(>50.0%).G+菌對萬古黴素、替攷拉寧總耐約率為0.對青黴素類、喹諾酮類、剋林黴素等抗生素耐藥率較高(>40.0%).結論 (1)該院膽道感染以G-菌為主,主要緻病菌為大腸桿菌,腸毬菌有上升趨勢.細菌混閤感染多見于急性感染患者.(2)治療膽道感染首選對大腸桿菌耐藥率低的廣譜抗生素.頭孢他啶、環丙沙星可用于膽道輕度感染,中重度感染首選頭孢哌酮/舒巴坦或阿米卡星,亞胺培南、萬古黴素可作為臨床二線用藥治療其他藥物治療無效的感染.
목적 분석담도질병환자담즙치병균적분포특점급내약정황,이편합리선택항생소.방법 추취2007년6월지2008년3월재상해교통대학의학원부속인제의원보외과행담도수술적195례환자적술중담즙,병선취24명건강인작위대조,진행세균배양급약물민감시험.결과 195례담도질병환자담즙배양양성솔위22.6%(44/195),기중혼합감염솔위25.0%(11/44).배양균주55주,균충16충,기중G-균점61.8%(34/55),C+균점34.6%(19/55),진균점3.6%(2/55).주요치병균위대장간균(27.3%)、음구장간균(12.7%)、분장구균(12.7%)、시장구균(10.9%).24명건강인정상담즙배양양성솔위4.2%(1/24),위대장간균.약물민감실험결과현시:G-균대미락배남총내약솔최저(2.8%),기차위아알배남(5.6%)、두포고동/서파탄(22.8%)、아미잡성(28.7%).대청매소류、규강동류、부분삼대두포균소류등항생소내약솔교고(>50.0%).G+균대만고매소、체고랍저총내약솔위0.대청매소류、규낙동류、극림매소등항생소내약솔교고(>40.0%).결론 (1)해원담도감염이G-균위주,주요치병균위대장간균,장구균유상승추세.세균혼합감염다견우급성감염환자.(2)치료담도감염수선대대장간균내약솔저적엄보항생소.두포타정、배병사성가용우담도경도감염,중중도감염수선두포고동/서파탄혹아미잡성,아알배남、만고매소가작위림상이선용약치료기타약물치료무효적감염.
Objective To illustrate the bacteriology and their susceptibility to antibiotics in patients with biliary tract diseases and provide information for antibiotic choices. Methods The bile specimens were cultured and pathogens' susceptibility to antibiotics was obtained intraoperatively from 195 patients undergoing operations on biliary tract and 24 healthy liver donors from June 2007 to March 2008. Results Among 195 bile specimens collected from the patients intraoperatively,44 ones were found bacterial growth by culture(22. 6% ) ,in which 11 ones were mixed infections(25.0% ). Fifty-five bacterial strains belonging to 16 species were identified from these bile specimens. They included 34 Gram negative strains (61.8%), 19 Gram positive strains (34.6% ) and 2 fungal strains (3.6%). The commonest pathogens were Escherichia coil (27.3%), Enterobacter cloacae ( 12.7% ), Enterococcus faecalis ( 12. 7% ) and Enterococcus faecium ( 10.9% ). Among 24 bile specimens collected from the healthy liver donors, one was found Eseherichia coil growth by culture (4.2% ). The results of susceptibility test showed that the resistant rates of Gram negative strains to Meropenem was 2.8%, followed by Imipenem (5.6% ), Sulperazone (22.8%) and Amikacin (28.7%). In this study Gram negative strains were highly resistant to Penicillins, Quinolones, some third generation Cephalosporins and so on (>50.0% ). None of Gram positive strains were resistant to Vancomycin and Teicoplanin. They were highly resistant to Penicillins, Quinolones, Clindamycin and so on ( >40.0% ). Conclusious (1) Gram negative strains remain the commonest pathogens in biliary tract infection in Renji Hospital and the commonest pathogen is Escherichia coil The infection of enterococcus is going up. The mixed infection cases happen mostly in acute biliary infection. (2) To treat biliary infection the broad-spectrum antibiotics which are effective to Escherichia coil are optimal choices. Ceftazidime or Ciprofloxacin may be used in mild biliary infection. Sulperazone or Amikacin may be used in severe biliary infection. Imipenem and Vancomycins may be used as second choice to treat the infection which other drugs are ineffective to.