Changes in Microbial Profiles and Antibiotic Resistance Patterns in Patients with Biliary Tract Infection Over a Six-Year Period
Changes in Microbial Profiles and Antibiotic Resistance Patterns in Patients with Biliary Tract Infection Over a Six-Year Period
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DOI：
10.1089/sur.2019.041
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发表时间：
2019-04-24
影响因子：
2
通讯作者：
Zhang, Jianhua
中科院分区：
文献类型：
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作者：
Zhao, Jijun;Wang, Qin;Zhang, Jianhua
背景：胆道感染（BTI）是各种胆道疾病引起的胆道梗阻患者的常见并发症。为了改善BTI患者的管理，在这项为期6年的回顾性研究中评价了胆汁培养的微生物概况和抗生素耐药性模式。方法：2012年1月至2017年12月，共709例各种胆道疾病患者入组本研究。从术中穿刺或术后引流中采集胆汁标本，在无菌条件下进行微生物培养。根据标准常规进行微生物培养、鉴定和抗生素耐药性试验。结果：789份胆汁标本中574份（73%）培养阳性。革兰阴性杆菌386株（67%），革兰阳性球菌170株（30%），真菌18株（3%）。最常见的病原菌为大肠埃希菌（29%）和肺炎克雷伯菌（16%），超广谱β-内酰胺酶（ESBL）的阳性率分别为52%和21%。这两种细菌对常用抗生素（青霉素类、头孢菌素类和喹诺酮类）高度耐药，对碳青霉烯类、阿米卡星和哌拉西林-他唑巴坦高度敏感。其次是肠球菌属（19%），主要包括屎肠球菌（8%）和粪肠球菌（6%）。这两种细菌对头孢唑林和克林霉素耐药，但对替考拉宁、替加环素和万古霉素敏感。屎肠球菌比粪肠球菌对大多数测试的抗生素药物更耐药。年度统计分析表明，革兰阴性菌的检出率呈缓慢下降趋势，革兰阳性肠球菌的检出率呈缓慢上升趋势。此外，最常见菌株的总体抗生素耐药性在过去六年中一直在缓慢下降。结论：肠杆菌科（大肠杆菌和肺炎克雷伯菌）和肠球菌属（屎肠球菌和粪肠球菌）是引起BTI的常见病原菌，对常用抗生素耐药率高，对哌拉西林-他唑巴坦、碳青霉烯、阿米卡星和万古霉素高度敏感。胆汁中的微生物谱及其抗生素耐药模式发生了变化，这将有助于BTI的经验性治疗。
Background: Biliary tract infection (BTI) is a common complication in patients with biliary obstruction caused by various biliary tract disorders. To improve the management of patients with BTI, microbial profiles from bile cultures and antibiotic resistance patterns were evaluated in this six-year retrospective study. Methods: A total of 709 patients with various biliary tract disorders from January 2012 to December 2017 were enrolled in this study. Bile specimens were taken from intra-operative puncture or post-operative drainage for microbial culture under sterile conditions. Microbial culture, identification, and antibiotic resistance test were performed according to a standard routine. Results: Cultures were positive in 574 of 789 bile specimens (73%). Of all isolates, 386 were gram-negative bacilli (67%), 170 were gram-positive cocci (30%), and 18 were fungi (3%). The two most common micro-organisms were Escherichia coli (29%) and Klebsiella pneumoniae (16%), the extended-spectrum beta-lactamases (ESBL) positivity rates of which were 52% and 21%, respectively. Both bacteria were highly resistant to commonly used antibiotic agents (penicillins, cephalosporins, and quinolones), and highly susceptible to carbapenems, amikacin, and piperacillin-tazobactam. Enterococcus (19%) was the next most common bacteria isolated from bile samples, mainly including Enterococcus faecium (8%) and Enterococcus faecalis (6%). These two bacteria were resistant to cefazolin and clindamycin but sensitive to teicoplanin, tigecycline, and vancomycin. Enterococcus faecium was more resistant than Enterococcus faecalis to most of the tested antibiotic agents. Annual statistical analysis showed that the frequency of gram-negative enteric bacteria was decreasing slowly, but that of gram-positive enterococci was increasing slowly. Moreover, the overall antibiotic resistance rates of the most common strains have been decreasing slowly over the past six years. Conclusions: Enterobacteriaceae (Enterococcus coli and Klebsiella pneumoniae) and Enterococcus (Enterococcus faecium and Enterococcus faecalis) were the common pathogenic bacteria causing BTI, which exhibited high resistance to routinely used antibiotic agents and were highly sensitive to piperacillin-tazobactam, carbapenem, amikacin, and vancomycin. The microbial profiles from bile and its antibiotic resistance patterns have changed, which will help in the empirical treatment of BTI.