肝内胆管结石病原菌监测及抗菌药物使用合理性分析

摘要

Objective To understand the main pathogenic bacteria type and resistance rates in hepatolithiasis with biliary tract infection and evaluate the rationalization of antibacterial drugs usage in our hospital,with providing reference for the rational use of antimicrobial drugs and management.Methods The pathogen detection and drug sensitivity test results obtained from 422 patients with hepatolithiasis with biliary tract infection in our hospital from January 2014 to June 2016 were retrospectively analyzed.Result A total of 558 strains of pathogenic bacteria were isolated,including 368 strains of gram negative bacteria in which Escherichia coli detection rate accounted for the first (33.0%),Klebsiella pneumoniae (11.8%) and Pseudomonas aeruginosa (9.5%) and 190 strains of gram positive bacteria,with Enterococcus faecalis detection rate accounted for the first (17.9%),followed by Enterococcus faecium (6.8%).There is Over-dosage medications.It showed that ceftriaxone,cefoperazone/sulbactam and teicoplanin has higher DDDs resulting in DUI>1.Conclusion Anti-bacterial drug resistance was quite common in hepatolithiasis with biliary tract infection in our hospital.The use and management of antibiotics should be strengthened as soon as possible,and drugs should be selected according to antimicrobial sensitivity test to reduce the occurrence of drug-resistant bacteria.%目的 了解我院肝内胆管结石患者胆道感染常见菌群及其耐药性,评价临床抗菌药物使用的合理性,为临床治疗提供参考.方法 收集2014年1月-2016年6月我院收治的422例肝内胆管结石并发胆道感染患者的胆汁标本的病原菌检测及药敏试验结果进行回顾性分析.结果 共分离出558株病原菌,其中革兰阴性菌368株,以大肠埃希菌检出率占首位(33.0%),肺炎克雷伯杆菌(11.8%)及铜绿假单胞菌(9.5%);革兰阳性菌190株,以粪肠球菌检出率占首位(17.9%),其次是屎肠球菌(6.8%).亚胺培南西司他丁、头孢曲松、头孢哌酮舒巴坦、替考拉宁DDDs较大且DUI>1,存在超剂量用药.结论 我院肝内外胆管结石患者胆道细菌耐药情况较为严重,应加强抗菌药物使用管理,尽早明确病原菌,并根据药敏试验结果选用抗菌药物,减少耐药性的发生.