摘要
Abstract
Objective To investigate the trend of distribution and resistance rate of bile pathogens in patients with acute calculous cholecystitis(ACC)after percutaneous transhepatic gallbladder drainage(PTGBD).Methods Patients with ACC who underwent PTGBD were enrolled.Bile samples were collected for bacterial culture,species identification and antimicrobial susceptibility testing.Patients were stratified into two groups based on treatment period(2015～2020 cohort,abbreviated as Group A vs.2020～2025 cohort,abbreviated as Group B)and diabetic status(diabetic group vs.non-diabetic group)to compare pathogen distribution and resistance rate dynamics.The results of drug sensitivity tests were analyzed using WHONET software provided by World Health Organization bacterial surveillance network.Results A total of 105 patients were enrolled,66 patients in group A,39 patients in group B,29 bacterial species(92 strains)were isolated,including 12 gram-positive species(35.87％,33 strains/92 strains),16 gram-negative species(63.04％,58 strains/92 strains)and 1 fungal species(1.09％,1 strains/92 strains).The predominant gram-positive pathogens were Enterococcus faecium(33.33％,11 strains/33 strains),Enterococcus faecalis(18.18％,6 strains/33 strains)and Staphylococcus epidermidis(18.18％,6 strains/33 strains).Among gram-negative isolates,Escherichia coli(44.83％,26 strains/58 strains)and Klebsiella pneumoniae(27.59％,16 strains/58 strains)were the most prevalent.The primary pathogenic bacteria in groups A and B were ranked similarly,with no statistically significant difference in the positive rates of gram-positive and gram-negative cultures(all P＞0.05).In the analysis of changes in resistance rates,there were no statistically significant differences in the resistance rates of common antibiotics among gram-positive bacteria between the two groups(all P＞0.05).Among gram-negative bacteria,the resistance rate of Escherichia coli to tobramycin increased significantly(P＜0.05),while the overall resistance rates to other antibiotics remained stable.Compared between the diabetic and non-diabetic groups,there were no statistically significant differences in the positive rates of primary pathogenic bacteria in bile cultures or antibiotic resistance rates(all P＞0.05).Conclusion In the past decade,among the main pathogenic bacteria in ACC,Escherichia coli remained the predominant causative pathogen.Except for the increased resistance rate of Escherichia coli to tobramycin,the resistance rate of other drugs were not affected by time or diabetes.Antibiotics should be used according to the distribution and resistance of pathogens.关键词
急性结石性胆囊炎/胆汁细菌培养/细菌谱/糖尿病/耐药率变迁Key words
acute calculous cholecystitis/bile bacterial culture/bacterial spectrum/diabetes mellitus/change of drug resistance rate分类
医药卫生
