恶性梗阻性黄疸合并胆系感染106例病原菌分布及相关因素分析
Analysis of the pathogen distribution and related factors in 106 cases with malignant obstructive jaundice complicated with biliary infection
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摘要: 目的：对恶性梗阻性黄疸合并胆系感染相关的因素、胆汁病原菌的菌群分布及临床常用的抗菌药物的敏感性进行分析，为胆系感染抗菌药物的合理应用提供参考。方法：回顾分析106例行内镜逆行性胰胆管造影（ERCP）和经皮肝穿刺胆道引流（PTCD）的恶性梗阻性黄疸合并胆系感染的临床资料，其中高位恶性梗阻性黄疸65例，低位恶性梗阻性黄疸41例，ERCP通过术中插管进入胆道获取胆汁，PTCD术中通过7F或8F穿刺引流管进入胆道外引流获取胆汁，通过胆汁细菌培养和血培养以及各种相关因素进行对比研究，分析细菌谱与梗阻的部位和其他相关因素的关系。结果：106例胆汁中有52例胆汁培养阳性，胆系感染的主要病原菌为大肠埃希菌（33.0%）、肺炎克雷伯杆菌（9.61%）、阴沟肠杆菌（9.61%）、绿色链球菌（5.77%）、表皮葡萄球菌（5.77%）、血链球菌Ⅰ型（5.77%）、屎肠球菌（3.85%）、溶血性链球菌（3.85%）、恶臭假单胞菌（3.85%）。革兰阳性球菌对万古霉素、利奈唑烷和亚胺培南100%敏感。革兰阴性杆菌对厄他培南、亚胺培南、头孢哌酮/舒巴坦钠、复方新诺明、庆大霉素和丁胺卡那霉素100%敏感。大肠埃希菌的超广谱β-内酰胺酶阳性率为70.6%，肺炎克雷伯杆菌的超广谱β-内酰胺酶阳性率为40.0%。高龄、低位胆道梗阻及合并胆道感染症状这些因素能进入logistic回归方程，是胆系感染的独立危险因素。结论：恶性梗阻性黄疸病人胆系感染以大肠埃希菌感染为主；高龄、C反应蛋白升高低位胆道梗阻、病程中有胆道感染症状的病人在胆汁培养中更容易检出细菌。Abstract: Objective: To analyze the related factors,bile pathogen distribution and sensitivities of commonly used antibacterial drug in clinic for the treatment of malignant obstructive jaundice complicated with biliary infection,and provide the reference in the reasonable application of antibiotics for biliary infection.Methods: The clinical data of endoscopic retrograde cholangiopancreatography(ERCP) and percutaneous transhepatic cholangiodrainage(PTCD) in 106 cases with malignant obstructive jaundice complicated with biliary infection were retrospective analyzed,and 65 cases with high malignant obstructive jaundice and 41 cases with low malignant obstructive jaundice were found.The bile was harvested through intraoperative intubation into biliary tract in ERCP,and the bile was harvested through the drainage of 7 F or 8 F puncture tube into the biliary tract in PTCD.The bile bacteria culture,blood culture and various relevant factors were investigated,and the relationships between bacterial spectrum,and obstruction location and other related factors were analyzed.Results: Among 106 cases,the bile culture was positive in 52 cases.The main pathogenic bacteria of biliary infection were Escherichia coli(33.0%),Klebsiella pneumoniae(9.61%),Enterobacter cloacae(9.61%),Streptococcus viridans(5.77%),Staphylococcus epidermidis(5.77%),Streptococcus sanguis type Ⅰ(5.77%),Enterococcus faecium(3.85%),Streptococcus hemolyticus(3.85%) and Pseudomonas putida bacteria(3.85%) in turn.The sensitivities of gram-positive cocci to vancomycin,linezolid and imipenem were 100%.The sensitivities of gram-negative bacilli to ertapenem,imipenem,sulbactam/cefoperazone,cotrimoxazole,gentamicin and amikacin were 100%.The ESBL positive rates of Escherichia coli and Klebsiella pneumonia were 70.6% and 40.0%,respectively.The logistic regression equation analysis showed that the age,low biliary obstruction,and combination of biliary tract infection symptoms were the independent risk factors of biliary infection.Conclusions: The Escherichia coli is the main infection bacterium of biliary tract in patients with malignant obstructive jaundice.The bacterium is more likely to be detected in bile culture in elderly,C-reactive protein increasing,low biliary obstruction and biliary tract infection patients.
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Key words:
- obstructive jaundice /
- infection /
- factor analysis /
- bacteria spectrum /
- drug resistance
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