四川地区2012年至2013年胆道感染病原菌分布及耐药性分析

摘要

目的：了解四川地区胆道感染的病原菌分布及其对抗生素敏感性的变化,为临床合理用药提供参考和依据。方法：将2012年1月至2013年12月四川地区54家医院分离自胆道病原菌进行鉴定及抗菌药物敏感试验,依据2013年CLSI标准判断结果,使用WHONET 5.6软件进行数据分析。结果：54家医院两年间自胆道共分离出1886株细菌,其中包含了65种细菌,革兰氏阴性杆菌1469株(1469/1886,77.9%),革兰氏阳性球菌399株(399/1886,21.2%),排列前5位的细菌依次为：大肠埃希菌669株(669/1886,35.5%)、肺炎克雷伯菌194株(194/1886,10.3%)、粪肠球菌152株(152/1886,8.1%)、铜绿假单胞菌133株(133/1886,7.1%)、屎肠球菌152株(125/1886,6.6%)。其中肠杆菌科细菌对阿米卡星、头孢替坦、厄他培南仍保持相当高的抗菌活性,敏感率>90%；铜绿假单胞菌对阿米卡星、妥布霉素、头孢吡肟及头孢他啶的敏感率>70%；肠球菌对替考拉宁、替加环素仍100%敏感,对万古霉素的敏感率也高于90%。结论：胆道感染的细菌谱以肠道细菌最为常见,病原菌种类多样,耐药性不断变迁,及时了解病原菌分布及抗生素耐药性可为临床经验性治疗提供依据。%Objective:Investigate the distribution of pathogenic bacteria in Sichuan of biliary tract infection and its variability in sen-sitivity of antibiotics in order to provide a reference basis for clinical rational drug usage. Methods:From January 2012 to December 2013,54 hospitals in Sichuan area are separated from the biliary pathogenic bacteria identification and antimicrobial susceptibility test. According to the 2013 CLSI,data analysis is done by using WHONET 5. 6 software. Results:1886 bacterial strains were isolated in two years from biliary,including 64 species of bacteria,1469 strains of gram negative bacilli (1469/1886,77. 9%),399 strains of gram positive cocci (399/1 886,21. 2%). The top 5 kinds of bacteria are as follows:669 strains of Escherichia coli (669/1 886,35. 5%), Klebsiella pneumoniae 194 strains (194/1 886,10. 3%),152 strains of Enterococcus faecalis (152/1 886,8. 1%),133 strains of Pseudomonas aeruginosa (133/1 886,7. 1%),152 strains of Enterococcus feces (125/1 886,6. 6%),among which the antimicrobial activity of Enterobacteriaceae to Amikacin,cefotetan,ertapenem still maintains fairly high( >90% sensitive rate);sensitivity of Pseudo-monas aeruginosa to Amikacin,tobramycin,cefepime and ceftazidime is higher than 70%;sensitivy of enterococcus to teicoplanin,tige-cycline is still 100%,and sensitivy to vancomycin is higher than 90%. Conclusion:The intestinal tract bacterial was the most common pathogen in biliary infection,which has species diversity,and a resistant variation. Timely understanding of the distribution of pathogens and antibiotic resistance can provide a basis for clinical empirical therapy.