急性胰腺炎血液和胆汁培养的病原菌分布及耐药性分析

摘要

Objective To analyze the species distribution and resistant characteristics of pathogenic bacteria isolated from blood and bile cultures of patients with acute pancreatitis. Methods Blood and bile samples of patients with acute pancreatitis were cultivated and continuously monitored by BacT/Alert 3 D Automated Blood Culture System and the bacteria in the positive bottles were purified by being transferred timely to plate culture. The identifications of bacteria and drug tests were performed by Vitek 2 Compact Bacterial Automatic Analyzer. Results There were 245 strains of bacteria cultured in 1195 blood and 408 bile samples of patients with acute pancreatitis. Blood and bile culture detection rates were 9.2% and 20.8%, respectively. The six species detected in blood culture were coagulase negative Staphylococcus (CNS), Escherichia coli, Klebsiella pneumoniae, nearly smooth Candida, Acinetobacter baumannii, and Enterococcus faecium. The six species detected in bile culture were E. coli, E. faecium, K. pneumoniae, Enterococcus faecalis, CNS and A. baumannii. In blood and bile cultures, the detection rates of methicillin-resistant CNS were 91.1% and 60.0%, respectively. The detection rates of E. coli producing ESBLs were 52.0% and 66.7%, respectively. The detection rates of K. pneumoniae producing ESBLs were 45.5% and 70.0%, respectively. The resistant rates of A. baumannii to imipenem were 80.0% and 50.0%, respectively. Conclusion The pathogen detection rate is greater in bile culture than that in blood culture. CNS and E. coli were predominant pathogenic bacteria of blood and bile samples of patients with acute pancreatitis, respectively. The bacteria in blood and bile samples have different drug resistance.%目的:对急性胰腺炎患者感染的病原菌种类分布及其耐药情况进行分析.方法:利用BecT/Alert3D全自动血培养仪培养及监测急性胰腺炎患者血液和胆汁标本,待血液和胆汁培养呈阳性结果后及时转种平板培养基分离出病原菌, Vitek 2 Compact全自动微生物分析系统鉴定病原菌,分析药敏实验.结果:从1603例急性胰腺炎患者的血(1195例)和胆汁(408例)培养标本中,有196例病例共分离出245株病原菌.血液和胆汁培养检出率分别为9.2%和20.8%,血液培养检出菌由多到少的是凝固酶阴性葡萄球菌、大肠埃希菌、肺炎克雷伯菌、近平滑假丝酵母菌、鲍曼不动杆菌和屎肠球菌.胆汁培养检出菌由多到少的是大肠埃希菌、屎肠球菌、肺炎克雷伯菌、粪肠球菌、凝固酶阴性葡萄球菌和鲍曼不动杆菌.其中血液和胆汁中耐甲氧西林的凝固酶阴性葡萄球菌检出率为91.1%和60.0%.产ESBLs的大肠埃希菌分别为52.0%和66.7%;产ESBLs的肺炎克雷伯菌检出率分别为45.5%和70.0%,鲍曼不动杆菌对碳氢酶烯类的耐药率分别为80.0%和50.0%;结论:急性胰腺炎患者病原菌检出率最高的是胆汁培养.血流和胆汁培养分离的病原菌分别以凝固酶阴性葡萄球菌和大肠埃希菌为主,有各自的耐药性特点,并且差异较大.