内镜逆行胰胆管造影患者术后胆道感染的病原学分析及治疗

目的探究内镜逆行胰胆管造影(ERCP)术后患者胆道感染的原因及病原种类和耐药性,依据感染原因及病原种类为临床治疗提供相关参考。方法对莱芜市人民医院消化内科2009年3月-2013年3月740例行ERCP手术患者进行临床分析,根据梗阻部位分为:肝门组、肝总管组、胆总管组及胆管未见异常组,比较各组间感染的发生率;通过抽取胆道感染者的血样进行病原菌培养,对病原菌的含量进行分析。结果 740例患者有200例发生感染,总感染率为27.03%,肝门梗阻感染者120例,感染率为81.08%,肝总管组感染48例,感染率为40.00%,胆总管组感染22例,感染率为8.87%,胆管未见异常组感染10例,感染率为4.46%,四组之间相比,差异有统计学意义(P0.05);通过对感染者术后血液或者胆汁培养致病菌得到320株,其中革兰氏阴性占70.00%,革兰氏阳性菌占30.00%,占前三位的菌株分别是:大肠埃希菌、尿肠球菌和粪肠球菌;通过药敏试验可知革兰氏阴性菌对亚胺培南100%敏感,革兰氏阳性菌对万古霉素100%敏感,病原菌对其他抗菌药物均有一定的耐药性。结论 ERCP术后感染和梗阻部位有着显著的相关性,因此要依据梗阻部位做好防止感染发生的准备;通过病原菌的培养和耐药性的检测,从而提高ERCP术后胆道感染控制率,为临床治疗提供参考。

Etiology and treatment strategies of biliary tract infection in patients with undergoing endoscopic retrograde cholangiopancreatography

Objective To investigate the etiology and treatment strategies and types of drug-resistant pathogens of biliary tract infection in patients with undergoing endoscopic retrograde cholangiopancreatography （ERCP）,and provide reference for clinical treatment according to the type of infection pathogen.Methods Seven hundred and forty cases of patients with undergoing ERCP were selected from Mar.2009 to Mar.2013 in the People＇s Hospital of Laiwu City,obstruction classified as：hilar group,hepatic duct group,common bile duct group and bile ducts normal group,and the incidence of infection among four groups was compared; pathogens performed by extracting biliary tract infection were cultured.Results The overall infection rate was 27.03％,120 cases infected in hilar obstruction,the infection rate was 81.08％,48 cases infected in hepatic duct group,the infection rate was 40.00％,22 cases infected in bile duct group,infection rate was 8.87％,and no abnormal bile duct infection was 10 cases,the infection rate was 4.46％,there was significant difference among four groups （P ＜ 0.05） ; 320 lines pathogen were got from infected blood or bile cultures,which accounted for 70.00％ of Gram-negative,Gram-positive bacteria accounted for 30.00％,three strains accounting for the top were：Escherichia coli,Enterococcus faecalis,and urine; Gram-negative bacteria sensitive to imipenem was 100％ seen by susceptibility testing,Gram-positive bacteria sensitive to vancomycin was 100％,pathogens to other antimicrobial drugs had a certain resistance.Conclusion ERCP postoperative infection and obstruction has a significant correlation,so infection prevention is based on the site of obstruction by the cultivation and drug resistance detection of pathogens,the rate of post-ERCP biliary infection control for providing reference clinical treatment is increased.