摘要
目的研究胆道感染的相关临床异常指标,常见致病菌及其敏感抗菌药物。方法取2010年1-4月需行内镜下逆行胰胆管造影术(ERCP)进行诊治的102例患者的胆汁进行培养,分析胆汁培养结果与患者发热、血像异常、肝功能异常之间的关系;同时研究胆道感染的常见细菌谱及其耐药性,以便指导临床用药。结果 102例患者中,共有48例胆汁培养阳性,阳性率47.06%;培养结果阳性的患者中,临床上出现发热及血像异常明显高于培养阴性组,而胆汁培养阳性组的肝功能结果与培养阴性组之间差异无统计学意义;48例阳性结果中,共培养出54株细菌,其中革兰阴性菌占75.93%,革兰阳性菌占24.07%;革兰阴性菌对阿米卡星、头孢哌酮/舒巴坦及美罗培南敏感性较好,而革兰阳性菌利奈唑胺、万古霉素及替考拉林敏感性较好,而两类细菌对临床常用的喹诺酮类及未加β-内酰胺酶抑制剂的三代头孢敏感性较差,敏感率仅约40.0%。结论用临床症状判断胆道感染准确性有限;胆道感染以革兰阴性大肠埃希菌为主,仅对碳青霉烯类、氨基糖苷类及头孢哌酮/舒巴坦敏感,而对喹诺酮类及未加β-内酰胺酶抑制剂的三代头孢基本耐药。
OBJECTIVE To analyze the main clinical symptoms and pathogenic bacteria of biliary infection,and their resistance to antibiotics.METHODS From Jan 2010 to Apr 2010,the bile of 102 cases obtained by ERCP were detected,culture the bile,the pathogenic bacteria causing biliary infection and their resistance to antibiotics were analyzed respectively.The relationship between biliary infection and the results of clinical symptom and lab results were also studied.RESULTS A total of 48 patients bile had bacteria,the positive rate was 47.06%.There were 54 strains bacteria.41 strains（75.93%） were Gram-negative bacilli and Gram-positive cocci accounted for 24.07%,Gram-negative bacilli were sensitive to amikacin sulfate,imipenem,ertapenem,meropenem and cefoperazone sodium and sulbactam sodium with low resistance rate.Gram-positive cocci were sensitive to imipenem,vancomycin,linezolid.Patients with fever and/or increasing leucocyte counts got more positive biliary culture than that of patients without fever and/or normal leucocyte count.But there was no significant difference in biliary culture between patients with abnormal liver function and normal liver function,the sensitivity rate was only 40.0%.CONCLUSION Among the pathogens of cholangitis,Gram-negative bacilli were most common,which are mostly sensitive to carbapenems,aminoglycoside and cefoperazone sodium and sulbactam sodium,while resistant to the carbostyril and 3rd generation cephems that are widely used clinically.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2011年第15期3289-3291,共3页
Chinese Journal of Nosocomiology
关键词
胆道
感染
胆汁
培养
细菌
抗菌药物
Biliary tract
Infection
Bile
Culture
Pathogenic bacteria
Antibiotics
