探讨行腹腔镜胆道手术治疗的患者胆汁中致病菌及耐药性。

回顾性分析2013年10月至2017年9月收治的560例行腹腔镜胆道手术治疗的患者资料，对患者胆汁内的细菌进行分离培养，使用API细菌鉴定板条对细菌进行鉴定；采用纸片琼脂扩散法行药敏试验；使用WHONET 5.6软件(WHO细菌耐药监测中心)对数据行分析。采用SPSS 19.0行统计学分析，采用U检验及卡方检验分析组间数据差异，P<0.05则认为差异存统计学意义。

急诊手术组患者细菌培养阳性率为96.0%显著高于择期手术组的5.0%(P<0.05)；在全部病原菌中，大肠埃希菌占比最高；粪肠球菌对克林霉素、红霉素耐药率大于50.0%，屎肠球菌对青霉素、氨苄西林、左氧氟沙星、四环素、克林霉素、红霉素、环丙沙星、链霉素、庆大霉素耐药率大于50.0%，凝固酶阴性葡萄球菌对青霉素、克林霉素、红霉素耐药率均大于50.0%；大肠埃希菌对头孢呋辛、头孢噻肟、氨苄西林、复发磺胺甲噁唑耐药率大于50.0%，肺炎克雷白杆菌对头孢吡肟、头孢呋辛、头孢噻肟、氨苄西林、复发磺胺甲噁唑耐药率大于50.0%，变形杆菌对头孢呋辛、头孢噻肟、氨苄西林、复发磺胺甲噁唑耐药率大于50.0%。

在行腹腔镜胆道手术治疗患者中，择期胆道手术可以不用抗生素，胆道感染的患者根据药敏分析选用相应抗生素。

To investigate the pathogenic bacteria and drug resistance in patients’ bile after laparoscopic biliary tract surgery.

From October 2013 to September 2017, 560 patients received laparoscopic biliary tract surgery were enrolled into present study. Biliary bacteria were cultured and identified by API bacteria identification strip, then the agar diffusion method was used for drug susceptibility test, finally the WHONET 5.6 software (WHO bacterial resistance monitoring center) were used to analyze data rows.

Positive rate of bacterial culture in emergency surgery group (96.00%) was significantly higher than (5.00%) in elective surgery group (P<0.05); In all pathogenic bacteria, the account of Escherichia coli was the highest; Enterococcus faecalis to clindamycin and erythromycin resistance rate were more than 50%, Enterococcus faecalis to penicillin, ampicillin and levofloxacin, tetracycline, clindamycin, erythromycin, ciprofloxacin, gentamicin, streptomycin resistance rate were more than 50%; The coagulase negative staphylococci rate of resistant to penicillin, clindamycin and erythromycin were greater than 50%; rate of resistant Escherichia coli to cefuroxime, cefotaxime, ampicillin, sulfamethoxazole was greater than 50%, rate of Klebsiella pneumoniae resistant to cefepime, cefuroxime, cefotaxime, ampicillin, sulfamethoxazole was more than 50%. And the rate of proteus resistance to cefuroxime, cefotaxime, ampicillin, sulfamethoxazole and sulfamethoxazole was more than 50%.

Patients should not be treated with antibiotics if they could receive elective laparoscopic biliary surgery, and the drug sensitivity analysis should be done before they used antibiotics.