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目的探讨肝胆外科胆汁感染的现状及胆汁细菌谱与耐药性。方法收集832例行胆道手术患者的胆汁,进行细菌培养及药敏试验。结果送检胆汁832例,367例培养出细菌,阳性率为44.11%。共分离培养出细菌426株,其中革兰阴性杆菌297株(占69.72%),革兰阳性球菌113株(占26.53%),真菌13株(占3.05%),革兰阳性杆菌3株(占0.70%)。主要革兰阴性杆菌对碳青霉烯类和四环素类药物耐药率最低,对青霉素类药物耐药率最高。粪肠球菌对常用抗生素的耐药性普遍比屎肠球菌低。结论胆汁感染以肠源性细菌为主,主要是大肠埃希菌和肺炎克雷伯菌,其次为肠球菌,且对常用抗生素的耐药性较高。重视胆汁细菌培养及鉴定有助于指导临床医生从经验治疗过渡到目标治疗,从而提高胆道感染的精确治疗。
Objective To investigate the status of bile infection in hepatobiliary surgery and the spectrum and drug resistance of bile bacteria. Methods Bile was collected from 832 patients undergoing biliary tract surgery for bacterial culture and drug susceptibility testing. Results 832 cases of bile sent to check, 367 cases of bacteria cultured, the positive rate was 44.11%. A total of 426 bacteria were isolated and cultured, of which 297 (69.72%) were Gram-negative bacilli, 113 (26.53%) were Gram-positive cocci, 13 (3.05%) were fungi and 3 were Gram-positive bacilli 0.70%). The main Gram-negative bacilli have the lowest rates of resistance to carbapenems and tetracyclines and the highest rates of resistance to penicillins. Enterococcus faecalis commonly used antibiotic resistance than Enterococcus faecium low. Conclusions Biliary infection is mainly intestinal bacteria, mainly Escherichia coli and Klebsiella pneumoniae, followed by enterococci, and the resistance to commonly used antibiotics is high. Emphasis on bile bacterial culture and identification can help guide clinicians from the empirical treatment of the transition to the target treatment, thereby enhancing the accurate treatment of biliary tract infections.