Analysis Of Bacteria Distribution And Drug Sensitivity In Patients With Biliary Tract Infection

Objective: to understand the hospital area with the new changes of populationdistribution of bacteria in bile of biliary tract infection in recent years andantimicrobial susceptibility changes, to provide reference for clinical treatment.Methods:1. Samples:①For open biliary tract surgery, intraoperative use ofdisposable sterile syringe direct puncture of the gallbladder or bile duct and bileextraction2~5ml bile， inject asepsis pipe immediately to save;②Forlaparoscopic biliary tract surgery, the use of sterile suction suction device to extractbile from sterile syringes;③Endoscopic Retrograde Cholangiopan creatography(ERCP): The patient after injection of oral sedative and antispasmodic, throughthe mouth along slowly into the esophagus endoscopic, endoscopic when enteringthe duodenum, rotate the camera to find the major duodenal papilla, the nasal ductby means of a guide wire was inserted into the biliary tract in major duodenalpapilla. Immediately after the use of disposable sterile syringe suction bile of2~5mL, rapid injection of sterile tube in the preservation, and then injected contrastagent;④percutaneous liver puncture biliary drainage (PTCD): intraoperativelocalization in colour to exceed, to avoid blood vessels to choose appropriatepuncture point, after routine disinfection spread towels and surface anesthesia, thepigtail tube under ultrasound guided puncture into the gallbladder or bile ducts, exitthe thread with disposable sterile syringes after extracting bile2~5ml, immediatelysave injection asepsis pipe;⑤T tube drainage of biliary postoperative infection,disposable sterile syringes connection T tube, extracting bile2~5ml, immediately save injection asepsis pipe;2. Training methods: within2h after sampling bloodspecimens of vaccination in37℃train12to24h tablet, purification with referenceto the ministry of health clinical testing center "test procedures";3. Detection: TheFrench VITEK-32bacteria automatic analysis system of gram-negative bacteriaidentification card GNI, gram-positive bacteria bacterial species identification ofGPI identification card; Using VITEK32full-automatic microbial analyzerdecongestion quick card GNS GPS-110-143, testing the drug resistance ofpathogenic bacteria;4. The data and processing: Using Excel to establish adatabase; Using statistical software WHONET4.2general descriptive analysis.Results:①Total strain544strains, including41kinds, including strains of G＋100strains (18.3%) strains of G－426strains (78.3%),18strains of fungi(3.4%)；②G－bacteria ranked in the top three is Escherichia coli (148strains,27.2%), Klebsiella pneumoniae (96strains, accounted for17.6%), andPseudomonas aeruginosa bacteria (38strains,6.9%), G＋bacteria in the top two isEnterococcus faecium strains (30,33.3%) and Enterococcus faecalis strains (30,accounting for33.3%)；③Increase the overall resistance of G－bacteria, resistantbacteria increased, especially to of Cefoperazone/sulbactam resistance growth isthe most outstanding (both greater than50%)；④The sensitivity of Escherichia coliand Klebsiella pneumoniae to the rate of the sensitivity to the treatment of the55%or the third was still maintained；⑤The carbopenems drug still has a highsensitivity；⑥Enterobacter cloacae and complex with low sensitivity tomeropenem, amikacin, tobramycin (less than50%), but for levofloxacin (73.7%),piperacillin (70.2%), but the performance is highly sensitive. For other rare species,the Enterobacter cloacae and similar；⑦The effect of vancomycin on the feces andthe feces of the feces was the best and the drug resistance rate was zero, and the clinical effect was the best；⑧the G＋bacteria resistant to gentamicin, ampicillin,Rina temozolomide, ciprofloxacin were less than15%;⑨G＋bacteria ofcefoperazone sulbactam, trimethoprim, sulfamethoxazole and trimethoprim,clindamycin, cefepime has high resistance rate, the resistant rate to47%-84%.Conclusion:①the prevalence rate of biliary tract infection is increasing，infection caused by bacterial species increased sharply, especially the opportunityto pathogenic bacteria and drug resistance mutation;②the bacteria infection causedby G－proportion than before the increase, which decreased the proportion ofEscherichia coli, and Pseudomonas aeruginosa incidence than Enterobacter cloacaeranked third; G＋the proportion of bacteria decreased, but the species changed little;fungi increased, but the ratio changed little;③the G＋bacteria and fungalresistance changed little, but G－antibiotic resistance increased rapidly;④the G－of bacteria to antibiotics in our department have universal resistance, but alsosignificantly increased of carbapenem resistance. We should adjust the medicationstructure in the future.