【作者】 李小四； 范陈良； 冯燕； 冯雪君； 宋国蓉； 吴晓燕；

【Author】 Li Xiaosi;Fan Chenliang;Feng Yan;Feng Xuejun;Song Guorong;Wu Xiaoyan;Department of Clinical Laboratory,The Second Hospital of Jiaxing;

【机构】 嘉兴市第二医院； 嘉兴市妇幼保健院；

【摘要】 目的回顾性分析2017年1月～2017年12月嘉兴学院附属第二医院胆囊结石伴急/慢胆囊炎确诊患者胆汁中分离的病原菌特点及耐药特性,为临床合理用药提供理论依据。方法回顾性收集2017年1月～2017年12月确诊胆囊结石伴急/慢性胆囊炎临床病例资料和胆汁标本,采用BD-phoenix100全自动微生物鉴定系统和VITEK2-compact全自动微生物鉴定系统对培养阳性菌株做菌种鉴定和抗菌药物敏感性试验;按照CLSI(Clinical Laboratory Standard Institude)文件中表型确证实验检测ESBLs (Extended-Spectrumβ-lactamases)、改良Hodge试验确认耐碳青霉烯类肠杆菌科细菌;应用WHONET5.4软件和SPSS17.0软件进行耐药性统计分析。结果 2017年1月～2017年12月确诊的胆囊结石伴急/慢性胆囊炎并送检胆汁培养的病例1505例(其中急性炎症627例、慢性炎症878例);临床各科室送检的胆汁标本,剔除同一病人重复送检的标本,共获得阳性菌株526株,主要分布在肝胆外科病区(98.1%,516/526)。胆汁培养阳性菌株中,革兰阴性杆菌360株(68.4%)、革兰阳性菌147株(27.9%)、真菌19株(3.6%);革兰阴性杆菌中最常见的病原菌主要是大肠埃希菌(26.4%,139/526)、肺炎克雷伯菌(12.0%,63/526)和阴沟肠杆菌(6.3%,33/526);革兰阳性菌中主要是屎肠球菌(7.8%,41/526)、粪肠球菌(7.2%,38/526)和链球菌属(19/526,3.6%);真菌中最常见的是白假丝酵母菌(3.0%,16/526);大肠埃希菌中,产ESBLs菌株占51.1%(71/139),所有菌株对美罗培南、亚胺培南、阿米卡星的耐药率分别是0.8%、2.2%和2.9%,对环丙沙星、左氧氟沙星、头孢唑林、氨苄西林、氨苄西林/舒巴坦、头孢噻肟、复方新诺明的耐药率高于45%;肺炎克雷伯菌中,产ESBLs菌株占30.0%(21/63),所有菌株对美罗培南、亚胺培南、阿米卡星、左氧氟沙星、哌拉西林/他唑巴坦、头孢他啶耐药率分别是1.8%、6.7%、3.2%、19.3%、19.4%和29.0%;阴沟肠杆菌对美罗培南、亚胺培南、阿米卡星、左氧氟沙星、环丙沙星、头孢他啶、头孢噻肟的耐药旅分别是3.0%、3.0%、3.0%、15.2%、18.2%、57.6%和63.6%;屎肠球菌对万古霉素、利奈唑胺、四环素、氨苄西林、环丙沙星、红霉素的耐药率分别是0、2.4%、22%、47.5%、63.5%和85.0%;粪肠球菌对环丙沙星、氨苄西林、利奈唑胺、万古霉素、红霉素和四环素的耐药率分别是13.2%、2.6%、5.3%、2.6%、86.8%和50%;白假丝酵母菌对氟康唑、伏立康唑、伊曲康唑、5-氟胞嘧啶的敏感性均100%。结论胆结石伴胆囊炎患者胆汁培养阳性率为34.9%;病原菌分布广泛,以大肠埃希菌和肺炎克雷伯菌为主,其次是屎肠球菌和粪肠球菌;不同病原菌耐药性差异较大,对碳青霉烯类药物和万古霉素依旧具有很高敏感性,肝胆外科围手术期,临床应根据术中胆汁培养的流行病原菌及药敏资料,合理使用抗菌药物。更多还原

【Abstract】 [Abstact] Objective To investigate the clinical distribution and antibiotic resistance of pathogens isolated form choledocholithiasis patients complicated with biliary tract infections between Jan,2017 and Dec,2017 in the second hospital of Jiaxing,in order to provide evidence for clinical rational use of antibiotics.Methods VITEK2-compact and BD-phoenix100 were used to indentify the positive strains and determine the antibiotic sensitivity;Phenotypic confirmatory test based on the Clinical Laboratory Standard Institude(CLSI)criteria for ESBLs(Extended-Spectrum β-lactamases);Modified Hodge Test(MHT) based on the CLSI criteria for suspected Carbapenem-resistant Enterobacteriaceae(CRE);WHONET5.4 and SPSS17.0 were adopted for analyzing the antibiotic sensitivity results and statistical analysis of data,repestively.Results A total of 526 strains were collected from Jan,2017 to Dec,2017 in 1505 choledocholithiasis patients complicated with biliary tract infections(627 patients with acute,878 patients with chronic).The strains were mainly distributed in Hepatological surgery department(98.1%,516/526);All the strains inculding 360 strains of gramnegative bacteria(68.4%),147 strains of gram-positive bacteria(27.9%) and 19 strains of fungi(3.6%).In gramnegative bacteria,the most common isolates was E.coli(26.4%),followed by Klebsiella pneumonia(12.0%) and Enterobacter cloacae(6.3%);the most common isolates in gram-positive bacteria were Enterococcus faecium(7.8%)、Enterococcus faecalis(7.2%)、Streptococcus(3.6%);the most common fungus was Candida tropicalis(3.0%);in Escherichia coli,the ESBLs producing strains accounted for 51.1%(71/139),the resistance rates to Meropenem、Imipenem、Amikacin were 0.8%、2.2%、2.9%,respectively and to Ciprofloxacin、Levofloxacin、Cefazolin、Ampicillin、Ampicillin-Sulbactam、Cefotaxime、Trimethoprim-sulfamethoxazole were above 45%;in Klebsiella pneumonia,the ESBLs producing strains accounted for 30.0%(21/63),the resistance rates to Meropenem、Imipenem、Amikacin、Levofloxacin、Piperasilin-tazobartan、Ceftazidime were 1.8%、6.7%、3.2%、19.3%、19.4% and29.0%,respectively;the resistance rates to Meropenem、Imipenem、Amikacin、Levofloxacin、Ciprofloxacin、Ceftazidime、Cefotaxime in Enterobacter cloacae were3.0%、3.0%、3.0%、15.2%、18.2%、57.6% and63.6%,respectively;the resistance rates to Vancomycin、Linezolid、Tetracycline、Ampicillin、Ciprofloxacin、Erythromycin in Enterococcus faecium were 0、2.4%、22%、47.5%、63.5% and 85.0%,respectively;the resistance rates to Ciprofloxacin、Ampicillin、Linezolid、Vancomycin、Erythromycin、Tetracycline in Enterococcus faecalis were 13.2%、2.6%、5.3%、2.6%、86.8% and 50%,respectively;Candida albicans were all sensitive to Fluconazole、Itraconazole、Voriconazole、5-Fluorocytosine.Conclusions 34.9% of bile from choledocholithiasis patients complicated with biliary tract infections were positive for pathogens;the pathogens were diverse,the most common pathogens were E.coli and Klebsiella pneumonia,followed by Enterococcus faecium and Enterococcus faecalis;Vancomycin、 Meropenem and Imipenem were the best choose for infections;The clinicians in Hepatological surgery department should pay more attention to the empirical use of antimicrobial agents according to prevalent pathogens and antimicrobial susceptibility texting in the Perioperative period.更多还原