目的 分析肝膽胰腺惡性腫瘤患者發(fā)生膽道感染的病原菌分布及耐藥特征，為臨床合理應用抗菌藥提供依據(jù)。方法回顧性對2015年1月—2019年12月天津市腫瘤醫(yī)院肝膽胰腺惡性腫瘤患者膽汁培養(yǎng)結果進行分析。結果 共納入標本287例，檢出菌株630株，分離出的革蘭陰性菌為引起肝膽胰腺惡性腫瘤患者膽道感染的主要病原菌，占分離病原菌的比例為54.1%，其次為革蘭陽性菌和真菌，分別占分離病原菌的39.4%、6.5%。檢出的革蘭陰性菌中以大腸埃希菌、肺炎克雷伯菌、銅綠假單胞菌、陰溝腸桿菌、鮑曼不動桿菌為主；檢出的革蘭陽性菌中以糞腸球菌、表皮葡萄球菌、屎腸球菌、鶉雞腸球菌、溶血葡萄球菌為主；檢出的真菌中以白色念珠菌為主。腸桿菌科細菌對碳青霉烯類、阿米卡星保持高度敏感，銅綠假單胞菌對碳青霉烯類抗菌藥耐藥率高，對阿米卡星保持高度敏感。葡萄球菌及腸球菌（對萬古霉素天然耐藥的鶉雞腸球菌除外）對萬古霉素及利奈唑胺高度敏感，葡萄球菌對苯唑西林耐藥率高。結論 肝膽胰腺惡性腫瘤患者膽道感染的主要致病菌為以腸桿菌及非發(fā)酵菌為主的革蘭陰性菌，其次為以腸球菌、葡萄球菌為主的革蘭陽性菌。腸桿菌、葡萄球菌、腸球菌的耐藥率與其他醫(yī)院既往研究相比略低或持平，但銅綠假單胞菌對碳青霉烯類抗菌藥耐藥率高于其他醫(yī)院的既往研究，耐甲氧西林表皮葡萄球菌（MRSE）檢出率與CHINET監(jiān)測數(shù)據(jù)持平。

Objective To analyze the distribution and drug resistance of pathogens causing biliary tract infection in patients with hepatobiliary and pancreatic malignant tumors, so as to provide the basis for clinical rational use of antibiotics.Methods The bile culture results of patients with hepatobiliary pancreatic malignant tumor in Tianjin Cancer Hospital from January 2015 to December 2019 were retrospectively analyzed. Results A total of 287 samples were included and 630 strains were detected. The Gram-negative bacteria were the main pathogens causing biliary tract infection in patients with hepatobiliary and pancreatic malignant tumors, accounting for 54.1% of the isolated pathogens, followed by Gram-positive bacteria and fungi, accounting for 39.4% and 6.5% respectively. The main Gram-negative bacteria detected were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterobacter cloacae and Acinetobacter baumannii. Enterococcus faecalis, Staphylococcus epidermidis, Enterococcus faecium, Enterococcus gallinarum and Staphylococcus haemolyticus were the main Gram-positive bacteria detected. Candida albicans was the main fungus detected. Enterobacteriaceae was highly sensitive to carbapenems and amikacin, Pseudomonas aeruginosa had high resistance to carbapenems and high sensitivity to amikacin. Staphylococcus and Enterococci (except Enterococcus gallinarum naturally resistant to vancomycin) were highly sensitive to vancomycin and linezolid, and Staphylococcus was highly resistant to oxacillin. Conclusion The main pathogenic bacteria of biliary tract infection in patients with hepatobiliary and pancreatic malignant tumors were Gram-negative bacteria mainly composed of Enterobacter and non fermentative bacteria, followed by Gram-positive bacteria mainly composed of Enterococcus and Staphylococcus. The drug resistance rates of Enterobacteriaceae, Staphylococcus and Enterococci were slightly lower or flat compared with previous studies in other hospitals, but the resistance rate of Pseudomonas aeruginosa to carbapenems was higher than that of other hospitals. The detection rate of MRSE was the same as that of Chinet monitoring data.

R978.1

廣西壯族自治區(qū)衛(wèi)生和計劃生育委員會科研課題（Z20180385）