华西医学

华西医学

胆汁培养病原体特点及感染类型分析

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目的 了解胆汁培养阳性患者病原体分布及抗菌药物使用特点,为合理使用抗菌药物提供依据。 方法 对某三级医院 2016 年 12 月 1 日—2017 年 11 月 30 日住院期间胆汁培养阳性患者资料进行回顾性研究,分析胆道感染和定植患者病原体分布、抗菌药物使用情况,胆道感染患者多重耐药菌感染等情况。 结果 研究期间共送检 299 份胆汁标本,培养阳性 158 份,阳性率 52.8%。筛选的 79 例胆汁培养阳性患者共检出 110 株病原体,其中革兰阴性(G)菌 66 株(60.0%)、革兰阳性(G+)菌 37 株(33.6%)、真菌 7 株(6.4%)。G 菌检出量前 3 位分别是大肠埃希菌 25 株(22.7%)、肺炎克雷伯菌 9 株(8.2%)、鲍曼不动杆菌 7 株(6.4%),G+ 菌检出量前 3 位分别是屎肠球菌 10 株(9.1%)、粪肠球菌 6 株(5.5%)、凝固酶阴性葡萄球菌 6 株(5.5%)。胆道感染患者 42 例,胆道定植患者 37 例,病原体均以 G菌为主。胆道感染患者共检出 10 株多重耐药菌,多重耐药菌组比非多重耐药菌组抗菌药物使用天数明显延长(t=2.129,P=0.039)。胆道感染患者抗菌药物目标性治疗比例为 76.2%;胆道定植患者胆汁培养阳性前抗菌药物合理使用率为 16.2%,胆汁培养阳性后抗菌药物合理使用率为 78.4%。 结论 胆汁培养病原体无论感染还是定植均以 G菌为主。疑似胆道感染患者,送检胆汁培养同时应积极送检血培养。胆汁培养阳性应区分感染和定植,并根据药物敏感性结果合理选用抗菌药物。

Objective To explore the pathogen distribution and the characteristics of antibiotics use of patients with positive bile culture in order to provide evidence for appropriate antibiotic use. Methods Using a patient-based approach, the clinical and laboratory data of patients with positive bile culture between December 1st 2016 and November 30th 2017 were retrospectively analyzed. The pathogen distribution and antibiotics use of patients with bililary duct infections and colonizations were analyzed. Multidrug-resistant organism infections of patients with bililary duct infections were studied. Results There were 299 submitted bililary samples and in which 158 were culture-positive (52.8%). One hundred and ten strains of pathogens were found in 79 patients with positive bile culture, including 66 strains of Gram-negative (G) organisms (60.0%), 37 strains of Gram-positive (G+) organisms (33.6%), and 7 strains of fungi (6.4%). The top three G organisms were Escherichia coli (25 strains, 22.7%), Klebsiella pneumoniae (9 strains, 8.2%), and Acinetobacter baumanii (7 strains, 6.4%). The top three G+ organisms were Enterococcus faecium (10 strains, 9.1%), Enterococcus faecalis (6 strains, 5.5%), and coagulase negativeStaphylococcus (6 strains, 5.5%). The number of patients with bililary duct infections and colonizations were 42 and 37, respectively, with pathogens occupied mainly by G bacteria. Ten strains of multidrug-resistant organisms were isolated from patients with bililary duct infections. Compared to patients with non-multidrug-resistant organism infections, the length of antibiotics use was longer in patients with multidrug- resistant organism infections (t=2.129, P=0.039). The rate of target therapy for antibiotics in patients with bililary duct infections was 76.2%. The rate of proper antibiotics use was 16.2% before positive bile culture and 78.4% after positive bile culture in patients with bililary duct colonizations. Conclusions Pathogens isolated from bile culture of infection and colonization are predominantly G organisms. The bile culture and blood culture should be done for patients with suspected bililary duct infection. Infection and colonization should be distinguished for positive bile culture and antibiotic should be chosen according to drug susceptibility test results.

关键词: 胆汁培养; 胆道感染; 胆道定植; 血培养; 抗菌药物使用

Key words: Bile culture; Biliary duct infection; Biliary duct colonization; Blood culture; Antibiotics use

引用本文: 郁新燕, 陈文森, 张翔, 张永祥, 李松琴, 张卫红, 赵茹, 刘波. 胆汁培养病原体特点及感染类型分析. 华西医学, 2018, 33(3): 284-288. doi: 10.7507/1002-0179.201801095 复制

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1. 黄洁, 李玛琳, 孙敏, 等. 梗阻性黄疸患者胆汁微生物群落限制性片段多态性分析. 中华实验外科杂志, 2014, 31(11): 2396-2398.
2. Yokoe M, Hata J, Takada T, et al. Tokyo guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci, 2018, 25(1): 41-54.
3. 高戈, 冯喆. 外科脓毒症及脓毒性休克现状与展望. 中华实验外科杂志, 2015, 32(2): 232-234.
4. Lüebbert C, Wendt K, Feisthammel J, et al. Epidemiology and resistance patterns of bacterial and fungal colonization of biliary plastic stents: a prospective cohort study. PLoS One, 2016, 11(5): e0155479.
5. 中华医学会外科学分会胆道外科学组. 急性胆道系统感染的诊断和治疗指南 (2011 版).中华消化外科杂志, 2011, 10(1): 9-13.
6. Park JW, Lee JK, Lee KT, et al. How to interpret the bile culture results of patients with biliary tract infections. Clin Res Hepatol Gastroenterol, 2014, 38(3): 300-309.
7. 黄勋, 邓子德, 倪语星, 等. 多重耐药菌医院感染预防与控制中国专家共识. 中国感染控制杂志, 2015, 14(1): 1-9.
8. Bornscheuer T, Schmiedel S. Calculated antibiosis of acute cholangitis and cholecystitis. Viszeralmedizin. 2014, 30(5): 297-302.
9. 王秋霞. 胆道感染人群胆汁中细菌最新分布情况及对抗菌素敏感性的变化分析. 河北医药, 2017, 39(6): 945-946.
10. 王志刚, 潘乐玉, 徐金莲, 等. 胆道感染致病菌分布及耐药性的研究. 中华实验外科杂志, 2015, 32(8): 1973-1975.
11. 孙志, 王鹏远, 李威, 等. 2012 年全国三级医院胆汁培养病原菌的构成及耐药性分析. 中国临床药理学杂志, 2015, 31(11): 1038-1041.
12. 周春妹, 胡必杰, 吕媛. 卫生部全国细菌耐药监测网 2011 年胆汁培养病原菌耐药监测. 中国临床药理学杂志, 2012, 28(12): 933-936.
13. 吕骅, 朱明炜, 牛小娟, 等. 外科胆道感染病原菌单中心 30 年变迁. 中华肝胆外科杂志, 2016, 22(9): 611-613.
14. 李儒, 刘波, 张卫红, 等. 2013-2015 年微生物培养中无菌标本送检情况分析. 南京医科大学学报: 自然科学版, 2017, 37(3): 332-334.
15. Weber A, Huber W, kamereck K, et al. In vitro activity of moxifloxacin and piperacillin/ sulbactam against pathogens of acute cholangitis. World J Gastroenterol, 2008, 14(20): 3174-3178.
16. Kochar R, Banerjee S. Infections of the biliary tract. Gastrointest Endosc Clin N Am, 2013, 23(2): 199-218.
17. Yu H, Guo Z, Xing W, et al. Bile culture and susceptibility testing of malignant biliary obstruction via PTBD. Cardiovasc Intervent Radiol, 2012, 35(5): 1136-1144.
18. 邹雪飞, 吴广利, 王伟, 等. 胆石症合并急性胆管炎患者胆汁及血液病原菌培养及药敏分析. 中华实验和临床感染病杂志: 电子版, 2015, 9(1): 91-95.
19. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control, 2008, 36(5): 309-332.
20. Weinstein MP, Doern GV. A critical appraisal of the role of the clinical microbiology laboratory in the diagnosis of bloodstream infections. J Clin Microbiol, 2011, 49(9 Suppl): S26-S29.
21. 《抗菌药物临床应用指导原则》修订工作组. 抗菌药物临床应用指导原则 (2015 年版). 北京: 人民卫生出版社, 2015.