老年胆道感染患者病原菌分布及抗菌药物的选择应用

发布时间：2018-03-18 08:26

本文选题：胆道感染　切入点：病原菌　出处：《重庆医学》2017年24期 　论文类型：期刊论文

【摘要】：目的了解老年(年龄大于或等于65岁)胆道感染患者胆汁中菌群情况及其耐药性,为临床医师正确选择敏感抗菌药物提供参考依据。方法采集302例胆道感染老年患者的胆汁,并行细菌培养及药敏试验,对结果进行统计学分析。结果 302例胆道感染患者胆汁标本培养阳性185例,阳性率为61.3%,共分离出病原菌192株;其中革兰阴性菌146株占76.0%,产超广谱β-内酰胺酶(ESBLs)细菌55株占37.7%;革兰阳性菌46株占11.0%,以肠球菌为主;引起胆道感染的主要病原菌依次为大肠埃希菌、肺炎克雷伯菌、肠球菌、阴沟肠杆菌。药敏试验结果显示:革兰阴性菌对厄他培南、亚胺培南敏感性最高,接近100.0%;其次为阿米卡星、哌拉西林他唑巴坦,耐药率7.5%、8.9%;对氨苄西林、哌拉西林、头孢唑啉、头孢呋辛高度耐药。革兰阳性菌对利奈唑胺、替加环素、万古霉素耐药率最低,对喹诺酮类、氨基糖苷类、四环素类耐药严重。结论老年患者胆道感染细菌仍以革兰阴性菌为主,对哌拉西林/他唑巴坦高敏感;肠球菌呈上升趋势,尤其是鹑鸡肠球菌(D群)。
[Abstract]:Objective to investigate the bacterial flora and drug resistance in bile of elderly patients with biliary tract infection (65 years old or older), and to provide a reference for clinicians to select sensitive antimicrobial agents. Methods the bile samples of 302 elderly patients with biliary tract infection were collected. Results 185 cases of bile culture were positive in 302 patients with biliary tract infection, the positive rate was 61.3%. 192 strains of pathogenic bacteria were isolated. Among them, 146 strains of Gram-negative bacteria accounted for 76.0 strains, 55 strains produced extended-spectrum 尾 -lactamases ESBLs55 strains occupied 37. 7%; 46 strains of gram-positive bacteria accounted for 11.0% of Enterococcus; the main pathogens causing biliary tract infection were Escherichia coli, Klebsiella pneumoniae and Enterococcus, respectively. Enterobacter cloacae. The results of drug sensitivity test showed that Gram-negative bacteria had the highest sensitivity to ertapenem, imipenem was the highest, close to 100.0, followed by amikacin, piperacillin and tazobactam, the drug resistance rate was 7.5% and 8.9%, ampicillin, piperacillin, cefazolin, Cefuroxime is highly resistant. Gram-positive bacteria have the lowest resistance to linazolamine, tegacycline, vancomycin, quinolones, aminoglycosides, Conclusion Gram-negative bacteria are still the main bacteria of biliary tract infection in elderly patients, which is highly sensitive to piperacillin / tazobactam, and Enterococcus is on the rise, especially Group D of Enterococcus of Quail Chicken.
【作者单位】：滨州医学院烟台附属医院肝胆外科;滨州医学院烟台附属医院临床检验中心;安徽医科大学第一附属医院外科实验中心;
【分类号】：R446.5

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