胆源性脓毒症患者的细菌学分析与治疗策略  

Bacteriological analysis and treatment strategy in patients with biliary sepsis

作　　者：张晔[1] 童荔[1] 唐朝霞[1] 姚纪友 朱艳萍[1] 胡晓光[1] 黎丽芬 黄顺伟[1] 蔡常洁[1] 

机构地区：[1]中山大学附属第一医院重症医学科,广州510080

出　　处：《中华肝胆外科杂志》2017年第4期235-238,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：广东省广州市科技计划（201607010186）

摘　　要：目的研究胆道感染导致脓毒症患者的细菌学分布特点，为临床早期合理用药提供依据。方法2014年8月至2016年7月中山大学附属第一医院外科ICU共收治胆源性感染患者214例。分析人口学资料、序贯器官衰竭评分、入ICU前抗感染治疗、住ICU时间，入ICU后留取细菌培养并分析非重复样本。结果符合纳入标准的胆源性脓毒症患者72例，分为脓毒症休克组和脓毒症非休克组，两组患者住ICU时长分别为（6．4±4．6）d、（2．3±1．8）d，P〈0．05），差异有统计学意义。培养结果显示，胆汁中分离出菌株48株，主要为大肠埃希菌（23株、47．9％）、粪肠球菌（8株、16．7％）、屎肠球菌（2株、4．2％）。引流液分离出菌株80株，主要为大肠埃希菌（21株、26．3％）、铜绿假单胞菌（9株、11．3％），肺炎克雷伯菌（6株、7．5％）。胆汁分离出的大肠杆菌对丁胺卡那霉素、亚胺培南、帕尼培南的药物敏感率超过90．0％。结论大肠埃希菌是导致胆道感染引起脓毒症的主要革兰阴性细菌，早期应用碳青霉烯类药物可减少胆源性脓毒性休克的发生。Objectives To access the bacteriology in patients with sepsis due to biliary tract infection to provide a basis for empirical selection of proper antibiotic treatment. Methods This is a single-center retrospective study on 214 patients with biliary tract infection admitted from August 2014 to July 2016 to the surgical intensive care units （ICU） of The First Affiliated Hospital of Sun Yat-sen University. To study the demographic information, sequential organ failure assessment （SOFA）, usage of antibiotics before ICU and duration of ICU were analyzed. Bile, peritoneal drainage and blood samples were collected. Results 47 septic shock patients and 25 septic patients due to biliary tract infection were enrolled in the trial. The two groups （the shock group vs. the sepsis group） had a significant difference in the duration of ICU stay [ （6.4 ± 4.6） d vs. （2.3 ± 1.8 ） d, P 〈 0.05 ]. 48 strains of pathogens were isolated from the bile samples. The major pathogens were Escherichia coli （ E. coli）（ n = 23, 47.9% ）, Enterococcus faecalis （ n = 8, 16.7% ） and Enterococcus faecium （n = 2, 4.2% ）. 80 strains of pathogens were isolated from the peritoneal drainage culture samples. E. coli, pseudomonas aeruginosa, and Klebsiella pneumoniae ranked the top 3 species, accounting for 26.3%, 11.3% and 7.5%, respectively. The sensitivity of E. coli isolated from bile to amikacin, imipenem and panipenem were all over 90.0%. Conclusions E. coli was the principal gram-negative bacterium in biliary infection induced sepsis. Early administration of carbapenemes may reduce the occurrence of septic shock in these patients.

关 键 词：抗生素 胆道感染 脓毒症 细菌分析 

分 类 号：R459.7[医药卫生—急诊医学]