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

Objective: To analyse the changes of biliary bacteria spectrum and drug sensitivity of patients with biliary infection and make better clinical pharmacotherapy.Methods: 1. Endoscopic retrograde cholangiopancreatography(ERCP): Antispasmodic medicine must be injected to patients firstly, remember to be aware of the patients' condition. Sterile syringes and sterile tube should be set aside. Duodenum mirror was then used for the patient line of ERCP, when the lens hit the duodenum, inserting tube into the bile duct through the duodenum big nipples. Injecting 5 ml bile into asepsis pipe that have already prepared and waiting for inoculation before injecting contrast material. 2. Percutaneous transhepatic cholangial drainage(PTCD): Choosing the puncture point varies according to different situations. Firstly,we need to prepare the conventional disinfection and spread towels,and then make the patient get local anesthesia. After using a sharp knife to broken skin, taking PTCD percutaneous needle puncture into the bile duct through the liver under the guidance of color doppler ultrasound. Pulling out the needle core and linking the stylophore to the injector. Extracting bile from patients for 5ml and take it all into the sterile tubes immediately. Pay attention to the overall process should be completed within 2 hours in order to take the subsequent analysis of the bacterial culture and their drug resistance[1].T tube drainage of bile: The T tube drainage of biliary tract infection patients were sent to culture.Training method: The collected bile of patients should be inoculated on blood plate and developing 12 to 24 hours under the condition of 37 ?. Gram-negative bacteria identification cards and gram-positive bacteria identification cards were provided by the French automatic bacteria analysis system VITEK 32.The resistant sensitivity of certain pathogenic bacteria were detected with VITEK 32 appropriative drug susceptibility card GNS-143 and GPS-110, respectively[2].Statistical analysis: The data were collected using Epi Data 3.1and all the statistical analysis were calculated by the SPSS 18.0 software. P<0.05 were considered statistically significant.Results: By the end of 2014-2015, the proportion of gram-negative bacteria in the total pathogenic bacteria were decreased significantly, and its proportion from 78% six years ago dropped to 74% in 2011-2012.While considering the gram-positive bacteria, there is no significant change during these years. Of all the infectious bile, the propotion of mixed infection is on the rise, especially the fungal infection which accounting for nearly 4.0%. It's worth noting that patients with fungal infection were often suffered from mixed bacteria infection.The analysis of drug resistance rate of several kinds of gram-negative bacteria in our study can be concluded as follows: the drug resistance rate of gram-negative bacteria from high to low were amikacin, cefepime, tobramycin, Shu Pu depth and Lmipenem. The drug resistance rate of gram-positive bacteria dung enterococcus and excrement enterococcus to vancomycin were 0, so we have resons to believe that it has a perfect clinical effect in application. The drug resistance rate of pathogenic bacteria to gentamicin, high concentrations of streptomycin, ciprofloxacin, rifampicin and rina thiazole were all less than 15 percents.The analysis of drug susceptibility test results showed that the fungi were sensitive to fluconazole and voriconazole but not to amphotericin B.Conclusion:(1) The first four pathogenic bacteria in patients with biliary tract infection in our hospital were e. coli(36.7%), klebsiella pneumoniae pneumonia subspecies(14.8%), dung enterococcus(14.5%) and sewer e. coli(8.2%).(2) The drug resistance rate of gram-negative bacteria from high to low were amikacin, cefepime, tobramycin, Shu Pu depth and Lmipenem.Lmipenem, tobramycin and piperacillin/he thiazole ba and amikacin were sensitive to the enterobacter cloacae and thus has a good clinical efficacy.Resistance of e. coli to imine culture deep south shope piperacillin/he thiazole ba jotham cefoxitin are 0, so its is suitable for clinical treatment.Klebsiella pneumoniaeare of high antibiotic resistance to some low levels of antibiotics such as ampicillin and levofloxacin,which the drug resistance rate are higher than 50%.To the patients who sufferd from gram-positive dung enterococcus and excrement enterococcus, vancomycin has a good clinical effect because of its low drug resistance rate. The drug resistance rate of pathogenic bacteria to gentamicin, high concentrations of streptomycin, ciprofloxacin, rifampicin and rina thiazole were all less than 15 percent, which could be applied in clinic as an appropriate.Fungi susceptibility test results indicated that Fungi are sensitive to voriconazole and fluconazole.(3) To the patients with biliary tract infection who has taken the antibiotic treatment, we should first consider the drug sensitive of gram negative bacteria. Shu Pu depth and amikacin can be used in patients with slight symptom. But to the patients with serious symptom, Lmipenem and Meropenem are suitable. After 3-days' antibiotic treatment,if there is no significant curative effect, we should then turn to the gram-positive bacteria infection and timely use of gram positive bacteria sensitive antibiotics, such as vancomycin. If the use of antibiotics for more than 13 days, it is necessary to take combination therapy with antifungal drugs.