胆管结石合并胆道细菌感染患者胆汁病原菌及其预后影响因素

目的探究胆管结石合并胆道细菌感染患者内镜逆行胰胆管造影术(ERCP)术中及术后胆汁检出病原菌构成及药敏结果,并分析患者预后的影响因素。方法选择郴州市第一人民医院2017年3月-2020年3月收治的120例胆管结石伴胆道细菌感染患者作为研究对象,患者均行ERCP,术中与术后收集胆汁进行细菌培养及药敏试验,并分析患者预后影响因素。结果术中与术后患者胆汁细菌培养阳性率分别为73.33%与52.50%,差异比较有统计学意义(χ²=11.162,P<0.001);术中与术后患者共分离出病原菌分别为114株与82株,其中革兰阴性菌分别为76株(66.67%)和61株(74.39%),两组病原菌构成差异比较无统计学意义;胆汁革兰阴性菌中大肠埃希菌对头孢唑林耐药性较高,而对头孢吡肟、亚胺培南耐药性较低;铜绿假单胞菌对磺胺甲噁唑/甲氧苄啶耐药性较高,对亚胺培南耐药性较低;肺炎克雷伯菌对环丙沙星耐药性较高,对亚胺培南耐药性较低;革兰阳性菌粪肠球菌对莫西沙星、环丙沙星耐药性较高,而对利奈唑胺、亚胺培南、万古霉素耐药性较低;胆汁中金黄色葡萄球菌对环丙沙星、庆大霉素耐药性高,对替考拉宁、利奈唑胺、万古霉素耐药性较低;多元Logistic回归分析结果显示,结石大小、泥沙样与块状混合样结石、结石数量为患者预后的影响因素(P<0.05)。结论胆管结石合并胆道细菌感染患者ERCP术中及术后胆汁病原菌主要为革兰阴性菌,并对多种抗菌药物耐药,治疗时应该慎重选择抗菌药物,患者预后不良主要由结石大小以及性状导致,需要重点关注。

Pathogens isolated from bile of bile duct stones patients complicated with biliary tract infection and influencing factors for prognosis

OBJECTIVE To explore the distribution of pathogens isolated from bile specimens of the bile duct stones patients complicated with biliary tract infection during and after endoscopic retrograde cholangiopancreatography(ERCP), observe the result of drug susceptibility testing and analyze the influencing factors for prognosis. METHODS A total of 120 bile duct stones patients complicated with biliary tract infection who were treated in the Chenzhou No.1 People′s Hospital from Mar 2017 to Mar 2020 were recruited as the study subjects, all of the patients underwent ERCP, the bile specimens were collected during and after the surgery so as to carry out the bacterial culture and drug susceptibility testing, and the influencing factors for the prognosis were analyzed. RESULTS The positive rate of bacterial culture of bile was 73.33% during the surgery, 52.50% after the surgery, and there was significant difference(χ²=11.162,P<0.001).Totally 114 strains of pathogens were isolated from the patients during the surgery, 82 strains after the surgery;76(66.67%) strains of gram-negative bacteria were isolated during the surgery, 61(74.39%) strains after the surgery, and there was no significant difference in the distribution of pathogens between the two groups.Among the gram-negative bacteria isolated from the bile specimens, the Escherichia coli strains were highly resistant to cefazolin, while the strains were less resistant to cefepime and imipenem;the Pseudomonas aeruginosa strains were highly resistant to sulfamethoxazole-trimethoprim, while the strains were less resistant to imipenem;the Klebsiella pneumoniae strains were highly resistant to ciprofloxacin, while the strains were less resistant to imipenem.Among the gram-positive bacteria, the Enterococcus faecalis strains were highly resistant to moxifloxacin and ciprofloxacin, while the strains were less resistant to linezolid, imipenem and vancomycin;the Staphylococcus aureus strains were highly resistant to ciprofloxacin and gentamicin, while the strains were less resistant to teicoplanin, linezolid and vancomycin.The result of multivariate logistic regression analysis showed that the size of stone, sand-like and massive mixed stones and number of stones were the influencing factors for prognosis of the patients(P<0.05). CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the bile specimens of the bile duct stones patients complicated with biliary tract infection during and after ERCP and are resistant to multiple antibiotics.It is necessary to reasonably use antibiotics during the treatment and pay great attention to the adverse prognosis that is caused by size and character of stone.