标题：肝硬化并发胆道细菌感染的病原菌分布特点及耐药性分析

      作者：郑康杰，黄旭明，温文川    汕头市第二人民医院感染科，广东 汕头 515021

      卷次： 2022年33卷3期

      【摘要】 目的 分析肝硬化并发胆道细菌感染患者的病原菌分布特点及耐药性。方法 收集2020年1月至2021年3月汕头市第二人民医院感染科收治的56例肝硬化并发胆道细菌感染患者的胆汁标本，对胆汁标本进行细菌培养，鉴定菌株种类分布情况以及对常见药物的耐药性。结果 56份胆汁标本中共分离出68株病原菌，其中革兰阴性菌39株，占57.35%，主要病原菌为大肠埃希菌(23.53%)、肺炎克雷伯菌(11.76%)、铜绿假单胞菌(8.82%)；革兰阳性菌28株，占41.18%，主要病原菌为粪肠球菌(16.18%)、屎肠球菌(10.29%)；真菌1株，占1.47%，主要为白色念珠菌(1.47%)；革兰阴性菌中大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌耐药性较高的药物均为氨苄西林，耐药率分别为 93.75%、100.00%、83.33%；革兰阳性菌中粪肠球菌耐药性较高的药物为青霉素 G (100.00%)和克林霉素(100.00%)，屎肠球菌耐药性较高的药物为四环素(85.71%)。结论 肝硬化并发胆道细菌感染患者的病原菌分布主要以革兰阴性菌、革兰阳性菌为主，耐药现象普遍存在，临床上需重视对患者的病原学检查，合理应用抗菌药物，但本研究也局限于样本量较少的缺陷，今后有待开展更高质量的研究。
      【关键词】 肝硬化；胆道细菌感染；胆汁培养；病原菌；抗生素；耐药性
      【中图分类号】 R575.2 【文献标识码】 A 【文章编号】 1003—6350（2022）03—0305—03

Distribution characteristics and drug resistance of pathogenic bacteria in patinets with liver cirrhosis complicatedwith biliary tract bacterial infection.
ZHENG Kang-jie, HUANG Xu-ming, WEN Wen-chuan. Department of Infection,the Second People's Hospital of Shantou, Shantou 515021, Guangdong, CHINA
【Abstract】 Objective To analyze the distribution characteristics and drug resistance of pathogens in patientswith liver cirrhosis complicated with biliary tract bacterial infection. Methods Bile specimens from 56 patients with liv-er cirrhosis complicated with biliary tract bacterial infection in Department of Infection, the Second People's Hospital ofShantou from January 2020 to March 2021 were selected as the research objects. Bile samples were cultured to identify thepathogens, and the species and distribution of strains and their resistance to common drugs were identified. Results A to-tal of 68 pathogens were isolated from 56 bile samples, Among the 68 pathogens, 39 were Gram-negative bacteria(57.35% ), mainly Escherichia coli (23.53% ), Klebsiella pneumoniae (11.76% ), and Pseudomonas aeruginosa (8.82% ).There were 28 Gram-positive bacteria, accounting for 41.18%, mainly Enterococcus faecalis (16.18%) and Enterococcusfaecium (10.29%). There was one fungal strain, accounting for 1.47%, which was Candida albicans (1.47%). The drugswith high drug resistance of Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa in Gram-negative bacteriawere ampicillin, and the drug resistance rates were 93.75%, 100.00% and 83.33%, respectively. Penicillin G (100.00%)and clindamycin (100.00%) were the drugs with high resistance to Enterococcus faecalis in Gram-positive bacteria, andtetracycline (85.71%) was the drug with high resistance to Enterococcus faecium. Conclusion The distribution of patho-genic bacteria in patients with liver cirrhosis complicated with biliary tract bacterial infection is mainly Gram-negativebacteria and Gram-positive bacteria, and drug resistance is widespread. Clinically, it is necessary to pay attention to theetiological examination of patients and rational use of antibiotics. However, this study is limited to the defect of smallsample size, and higher quality research needs to be carried out in the future.
      【Key words】 Cirrhosis; Biliary tract bacterial infection; Bile culture; Pathogenic bacteria; Antibiotics; Drug re-sistance