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  • Title: [Pathogens' distribution and changes of antimicrobial resistance in the bile of acute biliary tract infection patients].
    Author: Wu ZY, Wu XS, Yao WY, Wang XF, Quan ZW, Gong W.
    Journal: Zhonghua Wai Ke Za Zhi; 2021 Jan 01; 59(1):24-31. PubMed ID: 33412630.
    Abstract:
    Objective: To investigate the pathogens' distribution and antimicrobial resistance in the bile of acute biliary tract infection patients. Methods: The data of bile bacterial culture and drug sensitivity test of 223 acute biliary tract infection patients who underwent gallbladder puncture or endoscopic retrograde cholangiopancreatography drainage from July 2009 to July 2019 were analyzed retrospectively at Department of General Surgery,Xinhua Hospital,Affiliated to Shanghai Jiao Tong University School of Medicine.There were 141 males and 82 females with age of 67.3 years(range:28 to 93 years).Three to five milliliter of bile was extracted from each patient and sent to the laboratory for bacterial culture,identification and drug sensitivity test.The patients were divided into two groups according to the visiting time: the former group (n=124) was admitted from July 2009 to July 2014,and the latter group(n=99) was admitted from August 2014 to July 2019.The distribution of pathogenic bacteria and the changing trend of drug resistance rate of common bacteria in the two groups were compared.The results of drug sensitivity test were analyzed by WHONET software provided by WHO bacterial surveillance network.The drug resistance rates in different time periods were compared by χ2 test. Results: In this study,there were 147 cases of acute cholangitis and 76 cases of acute cholecystitis.A total of 376 strains of pathogenic bacteria were cultured.Among them,98 strains(26.1%) were gram-positive bacteria,269 strains(71.5%) were gram-negative bacteria and 9 strains(2.4%) were fungi.The top three gram-positive bacteria were Enterococcus faecium (49.0%,48/98),Enterococcus faecalis(20.4%,20/98),and Enterococcus luteus(7.1%,7/98).The top 5 gram-negative bacteria were Escherichia coli(33.5%,90/269),Klebsiella pneumoniae(13.8%,37/269),Pseudomonas aeruginosa(13.0%,35/269),Acinetobacter baumannii (12.6%,34/269),and Enterobacter cloacae(4.8%,13/269).From 2009 to 2019,there was no significant change in the proportion of gram-positive bacteria (former group vs. latter group: 25.3% vs. 28.2%) and gram-negative bacteria(former group vs.latter group: 74.7% vs. 71.8%) in the bile of patients with acute biliary tract infection.Gram-positive bacteria were mainly Enterococci(85.7%,84/98) and gram-negative bacteria were Escherichia coli(33.5%,90/269).Acinetobacter baumannii accounted for 7.8%(11/142) of gram-negative bacteria in the former group and 18.1%(23/127) in the latter group,an increase of 10.3% over previous five years.Pseudomonas aeruginosa had a downward trend,16.9% in the former group(24/142) and 8.7% in the latter group (11/127),the proportion decreased by 8.2%,and the other changes were not significant.The drug resistance rates of common gram-positive bacteria were relatively stable,and the drug resistance rates of Enterococcus faecium to many antibiotics were higher than those of Enterococcus faecalis.The resistance rates of gram-negative bacteria to most antibiotics showed an upward trend,among which Klebsiella pneumoniae showed an upward trend to most of antibiotics(former group: 0/15－4/13, latter group: 55.0%－70.0%; χ2=3.996－16.942, P=0.000－0.046).The drug resistance rates of Acinetobacter baumannii was generally higher,but there were no significant changes in the drug resistance rates of Acinetobacter baumannii between the two groups.The drug resistance rates of Pseudomonas aeruginosa to most antibiotics increased,and the overall drug resistance rates of Escherichia coli were stable and showed a slight upward trend. Conclusions: The main pathogens in bile of patients with acute biliary tract infection are gram-negative bacteria.The constituent ratio of various gram-negative bacteria had no significant change from 2009 to 2019,but the drug resistance rates shows an upward trend.Among the gram-negative bacteria, Escherichia coli is the most important pathogen,and the proportion has no significant change.The proportion of Acinetobacter baumannii in the former group was significantly higher than that in the former group.And the proportion of Pseudomonas aeruginosa has a decreased trend. 目的： 探讨急性胆道感染患者胆汁病原菌分布和耐药率的变化趋势。 方法： 回顾性分析2009年7月至2019年7月于上海交通大学医学院附属新华医院普通外科行胆囊穿刺或内镜下逆行胰胆管造影引流的223例急性胆道感染患者的临床资料，男性141例，女性82例，年龄67.3岁（范围：28~93岁）。每例患者抽取胆汁3~5 ml，送至检验科细菌培养室，对胆汁进行细菌培养、鉴定和药物敏感性试验。按照患者就诊时间分为前、后两组，前组（n=124）的收治时间为2009年7月至2014年7月，后组（n=99）的收治时间为2014年8月至2019年7月，对比两组患者的病原菌分布及常见细菌的耐药率变化趋势。采用WHO细菌监测网提供的WHONET软件对药物敏感性试验结果进行分析。不同时间段耐药率的比较采用χ2 检验。 结果： 本研究包括急性胆管炎患者147例，急性胆囊炎患者76例，共培养出病原菌376株。其中革兰阳性菌98株（26.1%），革兰阴性菌269株（71.5%），真菌9株（2.4%）。革兰阳性菌中前3位为屎肠球菌（49.0%，48/98）、粪肠球菌（20.4%，20/98）、铅黄肠球菌（7.1%，7/98）；革兰阴性菌中前5位为大肠埃希菌（33.5%，90/269）、肺炎克雷伯菌（13.8%，37/269）、铜绿假单胞菌（13.0%，35/269）、鲍曼不动杆菌（12.6%，34/269）、阴沟肠杆菌（4.8%，13/269）。2009年至2019年急性胆道感染患者胆汁中革兰阳性菌（前组∶后组为25.3%∶28.2%）与革兰阴性菌（前组∶后组为74.7%∶71.8%）的比例无明显变化。革兰阳性菌以肠球菌属（85.7%，84/98）为主，革兰阴性菌以大肠埃希菌（33.5%，90/269）为主。前组中鲍曼不动杆菌占革兰阴性菌比例为7.8%（11/142），后组为18.1%（23/127），比例较前5年上升10.3%；铜绿假单胞菌在前组中比例为16.9%（24/142），后组为8.7%（11/127），比例下降8.2%；其余菌株变化不显著。常见革兰阴性菌中，肺炎克雷伯菌对大部分抗菌药物的耐药率呈上升趋势（前组：0/15~4/13，后组：55.0%~70.0%；χ2=3.996~16.942，P=0.000~0.046）；鲍曼不动杆菌的耐药率总体较高，但在前、后两组中的耐药率无较大变化；铜绿单胞菌属对抗菌药物的耐药率有升有降；大肠埃希菌的总体耐药率较平稳，呈轻度上升趋势。 结论： 急性胆道感染患者胆汁病原菌中以革兰阴性菌为主，2009年至2019年各种革兰阴性菌的构成比无明显变化，但耐药率呈上升趋势；革兰阴性菌中，大肠埃希菌是最主要病原菌，感染比例无明显变化，鲍曼不动杆菌的感染比例大幅上升，铜绿假单胞菌的感染比例呈下降趋势。.
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