胆石症合并急性胆管炎患者胆汁及血液中病原菌培养及药敏分析

发布时间：2018-06-03 03:26

本文选题：胆石症 + 胆道感染　；参考：《滨州医学院》2015年硕士论文

【摘要】：目的：观察胆石症合并急性胆管炎患者胆汁及血液中病原菌的分布特征、培养阳性率及其二者的关系,并分析病原菌对抗菌药物的敏感性,指导临床合理选择和应用抗菌药物。方法：选取2011年1月至2015年2月本院消化内科诊断为急性胆道感染、经内镜逆行性胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP),术中证实存在结石的120例患者的胆汁标本,所有胆汁标本均进行普通细菌、厌氧菌及真菌培养,其中43例行血培养,分别对其病原菌培养及药敏结果进行分析,并探讨胆汁培养与血培养二者的关系,同时对120例患者术前经验性应用的抗菌药物进行统计分析。结果：120例胆汁培养者中87例检出病原菌,阳性率为72.5%。胆汁标本中共分离出病原菌92株,其中革兰阴性菌70珠,革兰阳性菌18株,真菌4株,革兰阴性菌中排名居前3位的细菌分别是大肠埃希菌(52株,56.5%)、克雷伯菌属(6株,6.5%)、阴沟肠杆菌(4株,4.3%)。43例血培养者19例检出病原菌,阳性率为44.1%。血培养中分离出病原菌19株,其中大肠埃希菌16株,肺炎克雷伯菌2株,梭杆菌属1珠。胆汁中革兰阴性菌对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦和阿米卡星敏感性较高(敏感率分别为94.3%、90.0%和84.3%),对左氧氟沙星敏感性最低(敏感率仅为22.9%),未发现对对亚胺培南及美罗培南耐药者。120例患者术前均经验性应用抗菌药物,68例应用单一抗菌药物抗感染,主要为左氧氟沙星(41/68),其次为头孢哌酮/舒巴坦(14/68)和其他(13/68)；52例两联抗感染治疗,主要为左氧氟沙星+甲硝唑(20/52)、头孢哌酮/舒巴坦+甲硝唑(18/52)和其他(14/52)。结论：1.胆石症合并急性胆道感染患者胆汁中及血液中的主要病原菌为革兰阴性菌,均以大肠埃希菌为主,且两者在病原菌分布构成上无明显差异。2.与既往认为胆道感染易合并厌氧菌感染不同,本实验中未分离出厌氧菌。3.头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、阿米卡星敏感性较高,可作为胆石症合并急性胆道感染的首选抗菌药物,亚胺培南、美罗培南作为备选抗菌药物,在严重感染或其他抗菌药物无效下考虑使用。4.左氧氟沙星、氨曲南在胆道结石并胆道感染患者中耐药率高,临床上经验性应用抗菌药物时应避免选用。
[Abstract]:Objective: to observe the distribution of pathogenic bacteria in bile and blood of patients with cholelithiasis complicated with acute cholangitis, the positive rate of culture and the relationship between them, and to analyze the sensitivity of pathogenic bacteria to antimicrobial agents, and to guide the rational selection and application of antimicrobial agents in clinic. Methods: from January 2011 to February 2015, 120 cases of choledocholithiasis confirmed by endoscopic retrograde cholangiopancreatography (ERCP) were diagnosed as acute biliary infection by endoscope retrograde cholangiopancreatography (ERCP). All bile samples were cultured with common bacteria, anaerobes and fungi, 43 of them were cultured in blood. The results of pathogen culture and drug sensitivity were analyzed, and the relationship between bile culture and blood culture was discussed. At the same time, 120 cases of preoperative experience of the use of antimicrobial agents were statistically analyzed. Results pathogenic bacteria were detected in 87 out of 120 cases of bile culture, and the positive rate was 72.5%. 92 strains of pathogenic bacteria were isolated from bile samples, including 70 beads of Gram-negative bacteria, 18 Gram-positive bacteria and 4 fungi. Among Gram-negative bacteria, 52 strains of Escherichia coli, 6 strains of Klebsiella, 4 strains of Enterobacter cloacae, 4 strains of Enterobacter cloacae and 43 cases of blood culture were found to be pathogenic bacteria, the positive rate was 44.1%. 19 strains of pathogenic bacteria were isolated from blood culture, including 16 strains of Escherichia coli, 2 strains of Klebsiella pneumoniae and 1 strain of Clostridium pneumoniae. Gram-negative bacteria in bile against cefoperazone / sulbactam, The sensitivity of piperacillin / tazobactam and amikacin was high (94.3% and 84.3%, respectively), and the sensitivity to levofloxacin was the lowest (the sensitivity rate was only 22.9%, no resistance to imipenem and meropenem was found in 0.120 cases before operation. 68 cases were treated with single antimicrobial agent, and 68 cases were treated with single antimicrobial agent against infection. Levofloxacin 41 / 68, cefoperazone / sulbactam 14 / 68) and other 13 / 68% of 52 cases were treated with levofloxacin metronidazole 20 / 52, cefoperazone / sulbactam / sulbactam 18 / 52) and other 14 / 52P. Conclusion 1. The main pathogenic bacteria in bile and blood of patients with cholelithiasis complicated with acute biliary tract infection were Gram-negative bacteria, which were mainly Escherichia coli, and there was no significant difference in the distribution of pathogenic bacteria between them. Different from the previous thought that biliary tract infection is easy to be complicated with anaerobic infection, no anaerobes. 3 were isolated in this experiment. Cefoperazone / sulbactam, piperacillin / tazobactam, amikacin are highly sensitive and can be used as the first choice of antimicrobial agents for cholelithiasis complicated with acute biliary tract infection, imipenem and meropenem as alternative antimicrobial agents. Consider using. 4 in the event of severe infection or other antimicrobial failure. Levofloxacin and aztreonam have high drug resistance in patients with cholelithiasis and biliary tract infection.
【学位授予单位】：滨州医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R575.6

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