CAJ | 학술논문

目的探讨胆道感染致病菌的分布及耐药性.方法收集308例胆道疾病患者的胆汁并送细菌培养加药敏实验,对病原菌耐药性及临床特征的关系进行统计学分析.结果 308例患者的胆汁标本中病原菌培养阳性151例,培养阳性率49.03％,共培养出病原菌159株,其中革兰氏阴性菌112株,占70.44％,革兰氏阳性菌45株,占28.30％,真菌2株,占1.26％.常见细菌依次为大肠埃希菌、肠球菌属、肠杆菌属、肺炎克雷伯菌、金黄色葡萄球菌.革兰氏阴性菌及革兰氏阳性菌均对部分临床常有抗菌药物具有耐药性,其中有革兰氏阴性杆菌对碳青霉烯类耐药,如亚胺培南.46株大肠埃希菌和16株肺炎克雷伯菌中分离出产超广谱β-内酰胺酶(ESBLs)细菌25株,检出率为39.68％,其中22例(88.00％)对β-内酰胺类抗菌药物及ESBLs抑制剂的复合制剂:哌拉西林钠/他唑巴坦钠敏感.ESBLs的检出率与胆道手术史,反复感染以及术后感染等因素相关.结论胆道感染致病菌仍以肠道细菌为主,以往临床常用抗菌药物正在逐渐降低抗菌活性,β-内酰胺类抗菌药物及ESBLs抑制剂复合制剂,如哌拉西林钠/他唑巴坦钠可作为复杂胆道感染一线用药.
목적 탐토담도감염치병균적분포급내약성.방법 수집308례담도질병환자적담즙병송세균배양가약민실험,대병원균내약성급림상특정적관계진행통계학분석.결과 308례환자적담즙표본중병원균배양양성151례,배양양성솔49.03％,공배양출병원균159주,기중혁란씨음성균112주,점70.44％,혁란씨양성균45주,점28.30％,진균2주,점1.26％.상견세균의차위대장애희균、장구균속、장간균속、폐염극뢰백균、금황색포도구균.혁란씨음성균급혁란씨양성균균대부분림상상유항균약물구유내약성,기중유혁란씨음성간균대탄청매희류내약,여아알배남.46주대장애희균화16주폐염극뢰백균중분리출산초엄보β-내선알매(ESBLs)세균25주,검출솔위39.68％,기중22례(88.00％)대β-내선알류항균약물급ESBLs억제제적복합제제:고랍서림납/타서파탄납민감.ESBLs적검출솔여담도수술사,반복감염이급술후감염등인소상관.결론 담도감염치병균잉이장도세균위주,이왕림상상용항균약물정재축점강저항균활성,β-내선알류항균약물급ESBLs억제제복합제제,여고랍서림납/타서파탄납가작위복잡담도감염일선용약.
Objective To explore the distribution and drug resistance of pathogens of patients with biliary tract infection.Methods The 30g bile specimens were collected from the patients with biliary tract diseases.These specimens were sent for bacterial culture and drug sensitive test,with analysis on the relationship between drug resistance of pathogens and clinical characteristics.Results 151 cases out of 308 bile specimens showed culture-positive pathogens,containing 159 strains,and the positive rate reached 49.03％.There were 112 strains of gram-negative bacteria,accounting for 70.44％,45 strains of gram-positive bacteria,accounting for 28.30％,and 2 strains of fungus,accounting for 1.26％.The common pathogens were Escherichia coli,Enterococcus,Enterobacter,Klebsiella pneumoniae and Staphylococcus aureus.Both gram-negative and gram-positive bacteria showed resistance to some kinds of antibiotics used commonly,including some gram-negative bacteria showing resistance to carbapenems such as lmipenem.There were 25 strains of β-lactamase-producing bacteria separated from 46 escherichia coli strains and 16 klebsiella pneumoniae strains,with positive rate of 39.68％,which containing 22 strains sensitive to the fixed-dose combination of β-lactam antibiotic and β-lactamase inhibitors such as piperacillin sodium/tazobactam sodium.The positive rate of β-lactamase-producing bacteria was correlated with bile tract operation history,repeated infection and post-operation infection.Conclusion The bacteria of biliary tract infection mainly come from intestinal bacteria,showing resistance to some kinds of antibiotics commonly used.The fixed-dose combination of β-lactam antibiotic and β-lactamase inhibitor such as piperacillin sodium/Tazobactam sodium can be considered as first choice to the complex biliary tract infection.