摘要
目的探讨胆道感染患者的胆汁中病原菌分布特点、耐药情况及发生胆道感染的相关危险因素。方法对2008年1月至2015年10月期间，胆道细菌感染患者的临床资料进行回顾性调查，分析致病菌及耐药情况，探讨影响胆道感染的因素。结果320例胆汁标本中有249例检出致病菌，阳性率为77．81％；共培养菌株40种356株，其中革兰阴性菌244株（68．54％），革兰阳性菌93株（26．12％），真菌19株（5．34％）。排列前三位的细菌依次为大肠埃希菌84株（23．60％），肺炎克雷伯杆菌60株（16．85％），屎肠球菌40株（11．24％）。药敏结果显示大肠埃希菌与肺炎克雷伯杆菌对头孢唑啉耐药率最高，对头孢西丁、阿米卡星较为敏感。胆道感染的Logistic多因素回归分析显示，年龄≥60岁（AOR=2．311，95％CI：1．292～4．135）和ERCP手术史（AOR=3．475，95％CI：1．587～7．607）是发生胆道感染的独立危险因素。结论胆道感染患者胆汁细菌以革兰阴性菌为主，治疗一般首先考虑应用对革兰阴性菌耐药率低的抗生素；对年龄较大（≥60岁）、既往有ERCP手术史的胆道疾病患者应及时关注有无胆道感染情况。
Objective To investigate the distribution, drug resistance of bile pathogenic bacteria, and the risk factors for biliary infection. Methods Clinical and laboratory data of patients hospitalized from January 2008 to October 2015 were reviewed for pathogenic bacteria and drug resistance, and the factors related to biliary tract infection were studied. Results Among all 320 cases, there were 249 cases of pathogenic bacteria in bile specimens, the positive rate was 77. 81%. There were 356 strains of pathogenic bacteria of 40 species, including 244 strains of gram negative bacteria （ 68.54%）, 93 strains of gram positive bacteria （ 26.12% ） and 19 strains of fungi （5.34%）. Top three bacteria were Escherichia coli （ 84 strains, 23.60%）, Klebsiella pneumonia （ 60 strains, 16. 85% ）, and Enterococcus faecium （ 40 strains, 11.24%）. The Escherichia coli and Klebsiella pneumoniae had the highest drug resistance to cefazolin, and they had a lower drug resistance to cefoxitin and amikacin. The multivariate analysis showed that age ≥ 60 years （AOR = 2. 311,95% CI： 1. 292-4. 135 ） and the history of ERCP operation （AOR = 3. 475,95% CI： 1. 587-7. 607） were independent risk factors for biliary tract infection. Conclusion Bacteria are mainly gram negative bacteria in the bile of patients with biliary tract infection, suggesting antibiotics with low resistant rate of gram-negative is the first choice. The age ≥60 years and history of ERCP surgery are independent risk factors for patients with biliary tract disease. Measures to prevent biliary infections in high-risk patients should be taken.
作者
张源净
蒋彩凤
袁宗丽
施斌
Zhang Yuanjing Jiang Caifeng Yuan Zongli Shi Bin(Department of Gastroenterology, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, Chin)
出处
《中华消化内镜杂志》
CSCD
北大核心
2017年第4期233-237,共5页
Chinese Journal of Digestive Endoscopy
基金
上海市科研创新项目（13ZZ061）.
关键词
胆道疾病
胆汁
细菌学
抗药性
危险因素
Biliary tract diseases
Bile
Bacteriology
Drug resistance
Risk factors
