目的：研究莱芜地区胆道感染患者胆汁中细菌谱的变化及其药物敏感性变化，为本地区胆道感染患者合理应用抗生素提供理论依据。方法：对2009年1月-2014年12月间收治的262例本地区胆道感染患者的胆汁细菌培养阳性的231株病原菌分布及耐药情况作回顾性分析。结果：对于2009年1月-2011年12月、2012年1月-2014年12月两个时间段90、172份胆汁标本中各有63、132份病原菌培养阳性，分别检出病原菌73、158株；所分离的病原菌以革兰阴性杆菌为主，2个时间段分别占78.07％、73.48％，革兰阳性菌分别为20.56％、21.97％，真菌分别占1.37%、4.55%；革兰阴性菌在胆道感染中所占的比率下降，而革兰阳性菌及真菌的比率上升；大肠埃希氏菌仍占最大比例，2个时间段分别为34.21%、31.82％，大肠埃希氏菌中ESBLs阳性耐药株分别为16.0％（4/25），54.8％(23/42)(P<0.05)，胆道感染的病原菌发生明显的变迁。结论：胆道感染的病原菌中主要以大肠埃希氏菌、肠球菌属等为主，6年来胆道感染的病原菌发生明显的变迁，临床应用广泛的抗菌药物耐药率增加。%Objective:To study the changes of biliary bacteria and drug sensitivity to antibiotics in patients with biliary tract infection in laiwu, to provide the theory basis for clinical medicaton.Methods:The data of 231 strains of microbes were found in 262 patients with positive bile culture from Jan 2001 to Dec 2006 and their sensitivity to antibiotics were retrospectively analyzed.Results: There were 63 and 132 positive samples respectively in 90 samples during the first half of this study (2009-2011)and 172 ones during the second half (2012-2014) as well as 73 and 158 strains cultured. Respectively, Gram-negative bacteria accounted for 78.07% and 73.48%, Gram-positive bacteria accounted for 20.56% and 21.97%, fungi accounted for 1.37% and 4.55%; Escherichia coli was the major one and accounts for 34.21%, and 31.82%, the rate of positive ESBLs bacteria were increasing (16.0% vs 54.8%,P<0.05).Varieties of pathogens of biliary tract have evidently changed.Conclusions:The main pathogens of biliary in fection are E. coli and Enterococcus . Varieties of pathogens of biliary tract have evidently changed during six years. The resistance of clinica antimicrobial is increasing.
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