摘要
目的观察胆道疾病患者胆汁中菌群分布状态,分析胆汁培养细菌药物敏感谱的变异,用以指导临床选择用药。方法选择胆道疾病患者156例,通过内镜逆行胆管造影术深插管收集胆汁进行细菌培养及药敏试验,其中48例另进行血培养。结果胆汁细菌培养阳性率为62.8％;革兰阴性菌占81.6％,革兰阳性细菌占18.4％。和以往相比,绿脓杆菌(40/114)和革兰阳性细菌(21/114)比例明显增加。血标本细菌培养阳性率仅为4.2％。10种药物敏感谱发生变化,西司他丁钠、舒普森(头孢哌酮钠+舒巴坦) 头孢哌翻钠、头孢他啶、环丙沙星等抗菌效果好于氨苄青霉素、头孢唑林钠、头孢呋肟钠、阿洛西林钠(P<0.01)。结论胆道疾病患者胆汁细菌检出率高,血培养阳性率低,应重视胆汁培养。胆汁中菌群分布较文献报道变化较大,药物敏感谱亦有明显变化。
Objective To observe the bacterioflora of bile and it' s drugs sensitivity in patients with bile duct diseases to serve as a guidance in medication. Methods Bile of 156 cases of patients with biliary disease was collected and cultured respectively during endoscopic retrograde cholangiopancreatography (ER-CP) by deep cannulation and sucking out bile through the catheter. Forty eight blood samples among them were cultured simultaneously. Ten kinds of drug papers were used to investigate the bacterial sensitivity. The data were analysed statistically- Results Bacteria positive rate of these 156 bile samples was 62. 8% , including Gram - negative bacteria (81.6% ) and Gram - positive bacteria (18. 4% ). These bacteria consist of Pseudomonas aeruginosa (35. 1% ) , Escherichia coli(22. 8% ) , Streptococcus faecalis (16.7%) ,Entero bacilliaerogenes(7. 9% ) ,Klebsiella(7. 0% ) , Citrobacter(6. 1% ) ,Acinetobacler lwqffi(2. 6% ) and Staphylo-coccus aureus( 1. 7% ). The bacteria positive rate was only 4. 2% in the 48 blood samples. Drug sensitive rates of bacteria against 10 kinds of drugs were changed in recent years. The result indicated that the sensitive rates of bacteria were significantly higher in ciprofloxacin, fortum, cefoperazone, sulbactam + cefoperazone and cilastatin than those in ampicillin,azlocillin, cefazolin sodium, eefuroxime(P < 0.01). Conclusion It suggested that the cultured results of bile samples should be emphasized, as the positive rate of bacteria in bile sample was higher than that of blood sample. The positive rate of bacteria in patients with biliary disease were significantly higher than those in patient with malignant obstructive lesion. The bacterioflora in this study was different from those of the previous reports. Drug sensitivities of the bacteria in biles were changed significantly in recent years.
出处
《中华消化内镜杂志》
2003年第1期24-26,共3页
Chinese Journal of Digestive Endoscopy
关键词
胆道疾病
胆汁
菌群分布
药物敏感性
Cholangiopancreatography, endoscopic retrograde
Biliary tract diseases
Bile
Bacteria infection
Bacterial sensitivity tests
