The Clinical Analysis Of Main Pathogenic Bacteria Of Biliary Infection After PTCD And The Drug Sensitive Test

Objective: To analyze the distribution of Affiliated Hospital of Qinghai University area due to biliary tract infection PTCD treatment of postoperative obstructive jaundice for the main pathogenic bacteria in the bile of the patients and the sensitivity to different antibiotics,and provide guidance for clinical treatment of this disease in this region.Methods: 1 samples collected for patients infected with PTCD after operation,the use of disposable sterile syringe(20ml)with PTCD 10-15 ml negative pressure drainage tube,extraction of bile samples,and immediately.2 specimens of bile specimens were inoculated immediately sampling,blood plate,time to 2 hours,then the blood plate placed in constant temperature incubator 12h-24 h thermostat is set at 37 DEG C,separation and purification of the standard test procedure according to the Ministry of health clinical inspection center ".3 detection methods: bacterial species identification for gram negative bacteria and gram positive bacteria identification card GNI identification card GPI automatic analysis system from the French VITEK-32 bacteria;drug sensitivity and the use of a special type VITEK-32 automatic microbial analyzer card resistance to pathogen detection.4 data processing: using the Excel database and the WHO;the use of VB language development and general descriptive analysis of the results of statistical software used to recommend WHONET bacterial resistance monitoring.Results:(1)Bile samples were collected in 219 cases,the cultivation strains were 253 strains,including 20 species,There were 194 gram negative bacteria(n = 76.7%)and gram positive bacteria(n = 20.9%)(n = 53),6 strains of fungi(2.4%);gram negative bacteria in the top three were E.93 strains(36.7%),pneumonia Klebsiella pneumoniae 39 strains(15.4%),18 strains of Pseudomonas aeruginosa(7.1%),gram positive bacteria were ranked in the top two were 17(6.7%)strains of Enterococcus faecium,Enterococcus faecalis 14 strains(5.5%);the Candida albicans,.3 strains (1.2%);(2)the top 3 gram negative bacteria: Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,against three pathogens were maintained antibacterial high sensitivity to imipenem,Amikacin,cefoxitin,piperacillin / tazobactam the top 2;The gram positive bacteria,Enterococcus faecium and Enterococcus faecalis,against two pathogens were antibiotics sensitivity to vancomycin,ciprofloxacin,linezolid,streptococcaceae synergism;the Candida albicans accounted for 1.2%,mainly of fluconazole,flucytosine,itraconazole,voriconazole were higher sensitivity.Conclusion: the pathogenic bacteria in bile of patients with biliary tract infection after PTCD treatment for obstructive jaundice in our hospital were mainly gram negative bacteria,followed by Gram positive bacteria and fungi.In this kind of disease treatment in future clinical,empirical treatment preferred gram negative bacteria sensitive antibiotics for infection in patients with mild,should first choose(or)of cefoxitin and piperacillin / tazobactam,due to the impact of Amikacin on the liver function of large.For patients with life-threatening infection is heavy,if not contraindicated,can choose imipenem,after 3 days of treatment,such as infection control is not ideal,then consider the gram positive bacteria with gram positive bacteria infection,the use or combined use of gram positive bacteria sensitive to antibiotics,such as ciprofloxacin and linezolid.Sicker patients can choose vancomycin,if there is still no remission after 2 weeks of infection,taking into account the fungal infection,when combined with antifungal agents such as fluconazole,itraconazole,voriconazole or flucytosine.