胆总管结石合并感染患者鼻胆管引流前后胆汁细菌分布及其耐药性
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解祥军

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Distribution and antimicrobial resistance of pathogens from bile in patients with choledocholithiasis and infection before and after nasobiliary drainage
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    摘要:

    目的分析胆总管结石合并胆道感染患者经内镜逆行胰胆管造影术(ERCP)取石术中及术后48 h胆汁中病原菌种类、分布特点及药敏情况,为临床抗菌药物的选择提供指导依据。方法选取2015年10月—2016年12月某院收集的胆总管结石合并胆道感染行ERCP取石术患者,分别对ERCP取石术中获得的胆汁(术中组)及ERCP取石术后48 h经鼻胆管引流获得的胆汁(术后组)进行细菌培养及药敏检测。结果共收集117例患者资料,术中组、术后组胆汁细菌培养阳性率分别为73.50%、47.86%,两组胆汁标本细菌培养阳性率比较,差异有统计学意义(P<0.05)。两组234份胆汁标本共培养出174株细菌,其中革兰阴性菌138株(79.31%),革兰阳性菌33株(18.97%),真菌3株(1.72%);术中组细菌105株,术后组细菌69株;术中组和术后组不同细菌种类分布比较,差异无统计学意义(P>0.05)。术中组和术后组检出率居前5位的细菌均为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、粪肠球菌 、阴沟肠杆菌。革兰阴性菌检出率居前3位的大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌对10种抗菌药物的敏感率均≥60.00%,大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌对哌拉西林/他唑巴坦、头孢他啶及左氧氟沙星耐药率相对较高;3种细菌对亚胺培南及美罗培南敏感率均为100.00%。革兰阳性菌中检出率较高的屎肠球菌、粪肠球菌对替考拉宁、万古霉素及利奈唑胺的敏感率均为100.00%。结论胆汁细菌感染仍以革兰阴性菌为主,胆总管结石合并胆道感染患者在无禁忌的情况下应尽早行ERCP取石术解除胆道梗阻;胆道感染经验性使用抗菌药物时,建议联合用药。

    Abstract:

    ObjectiveTo analyze the species, distribution characteristics, and antimicrobial  susceptibility of pathogens from bile of patients with choledocholithiasis and biliary tract infection during and 48 hours after lithotomy under endoscopic retrograde cholangiopancreatography (ERCP), so as to provide guidance for clinical antimicrobial choice. MethodsPatients who performed lithotomy under ERCP for treating choledocholithiasis and biliary tract infection in a hospital between October 2015 and December 2016 were surveyed, bile from patients during lithotomy under ERCP (intraoperative group) and 48 hours after lithotomy by nasobiliary drainage (postoperative group) were performed bacterial culture and antimicrobial susceptibility testing. ResultsData of 117 patients were collected, positive bacterial culture rate of bile in intraoperative group and postoperative group were 73.50% and 47.86% respectively, there was significant difference between two groups (P<0.05). A total of 174 bacterial strains were isolated from 234 bile specimens in two groups, gramnegative bacteria, grampositive bacteria, and fungi were 138 (79.31%), 33 (18.97%), and 3 (1.72%) strains respectively; 105 strains were from intraoperative group and 69 were from postoperative group; there was no significant difference in the distribution of bacterial species between intraoperative group and postoperative group(P>0.05). The top 5 bacteria in intraoperative group and postoperative group were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis, and Enterobacter cloacae. Susceptibility rates of Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa to 10 kinds of antimicrobial agents were all≥60.00%, resistance rates of Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa to piperacillin/tazobactam, ceftazidime, and levofloxacin were relatively higher; susceptibility rates of these three bacteria to imipenem and meropenem were all 100.00%. Among grampositive bacteria, susceptibility rates of Enterococcus faecium and Enterococcus faecalis to teicoplanin, vancomycin, and linezolid were all 100.00%. ConclusionGramnegative bacteria is the main pathogen causing biliary tract infection, patients with choledocholithiasis and biliary tract infection should perform lithotomy under ERCP as early as possible in case of no contraindication, so as to relieve biliary obstruction; combined antimicrobial use is suggested for the empiric antimicrobial treatment.

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赵嘉美,郭丹丹,李文利,等.胆总管结石合并感染患者鼻胆管引流前后胆汁细菌分布及其耐药性[J]. 中国感染控制杂志,2018,17(6):512-516. DOI:10.3969/j. issn.1671-9638.2018.06.010.
ZHAO Jiamei, GUO Dandan, LI Wenli, et al. Distribution and antimicrobial resistance of pathogens from bile in patients with choledocholithiasis and infection before and after nasobiliary drainage[J]. Chin J Infect Control, 2018,17(6):512-516. DOI:10.3969/j. issn.1671-9638.2018.06.010.

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  • 收稿日期:2017-11-08
  • 最后修改日期:2018-01-08
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  • 在线发布日期: 2018-06-28
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