目的 了解重庆地区社区获得性急性胆囊炎和急性胆管炎患者胆汁培养及药敏试验结果的差异.方法 社区获得性急性胆囊炎患者169例,急性胆管炎97例,术中抽取胆汁并立即送需氧培养及药敏试验,胆囊胆汁为A组,胆管胆汁为B组.结果 A组和B组胆汁培养阳性率分别为24.9%和64.9%(P<0.05).16例同时抽取胆囊胆汁和胆总管胆汁的患者中,4例(25.0%,4/16)结果不一致.A组主要细菌为大肠埃希菌(28.0%)、肺炎克雷伯菌(24.0%)和阴沟肠杆菌(16.0%);B组主要细菌为大肠埃希菌(39.7%)、肺炎克雷伯菌(19.2%)和屎肠球菌(12.3%).A、B两组革兰氏阴性菌耐药率最低抗生素为阿米卡星(0%、0%)、厄他培南(0%、0%)、亚胺培南(0%、7.0%)、哌拉西林/他唑巴坦(0%、7.0%).A、B两组革兰阳性菌耐药率最低抗生素为替加环素(0、0)、利柰唑胺(0、0).两组多重耐药菌株比例分别为24.0%和35.6%(P>0.05).结论 社区获得性急性胆囊炎与社区获得性急性胆管炎患者胆汁培养存在差异,但当前主要细菌均为大肠埃希菌和肺炎克雷伯菌.两组细菌耐药情况均较严重,革兰氏阴性菌最敏感的抗生素为阿米卡星、厄他培南、亚胺培南、哌拉西林/他唑巴坦,革兰阳性菌最敏感的抗生素为替加环素、利柰唑胺.%Objective To understand whether it had differences in bile culture and drug susceptibility test between patients with community-acquired acute cholecystitis and patients with community-acquired acute cholangitis at present.Methods 169 patients with community-acquired acute cholecystitis and the 97 patients with community-acquired acute cholangitis in our department were selected prospectively,in which 16 patients suffered from both community-acquired acute cholecystitis and community-acquired acute cholangitis.Bile sample was extracted in operations and delivered to perform aerobic culture and drug sensitivity test.The bile samples coming from cholecyst were divided into group A,while the bile samples coming from bile duct were divided into group B.Results The positive rates of bile culture in group A and group B were separately 24.9% and 64.9%(P<0.05).The result of the sample coming from cholecyst and the result of the sample coming from bile duct were not the same in 4 patients of the 16 patients who suffered from both community-acquired acute cholecystitis and community-acquired acute cholangitis simultaneously.The main bacteria of acute cholecystitis included Escherichia coli(28.0%),Klebsiella pneumonia(24.0%)and Enterococcus faecium(16.0%).The main bacteria of acute cholangitis included Escherichia coli(39.7%),Klebsiella pneumonia(19.2%)and Enterobacter cloacae(12.3%).The antibiotics which were lowly resistant to gram negative bacteria in the two groups(A and B) included amikacin(0%/0%),ertapenem(0%/0%),imipenem(0%/7.0%)and piperacillin/tazobactam(0%/7.0%).The antibiotics which had lower resistant rates to gram positive bacteria in the two groups included tigecycline(0%/0%)and linezolid(0%/0%).The proportions of the multidrug-resistant strains in the two groups were separately 24.0% and 35.6%(P>0.05).Conclusion Some difference exist in the results of bile culture between patients with community-acquired acutecholecystitis and patients with community-acquired acute cholangitis,but the main bacteria of the both two types of biliary tract infection are Escherichia coli and Klebsiella pneumonia.The drug resistance is serious in the both infections,and the most sensitive antibiotics to gram negative bacteria include amikacin,ertapenem,imipenem,piperacillin/tazobactam,and the most sensitive antibiotics to gram positive bacteria include tigecycline,linezolid in the both infections.
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