梗阻性黄疸患者经内镜逆行胰胆管造影术后胆道感染的病原菌分布、耐药性及影响因素分析  

Pathogenic Bacteria Distribution, Drug Resistance and Influencing Factors of Biliary Tract Infection in Patients with Obstructive Jaundice after Endoscopic Retrograde Cholangiopancreatography

作　　者：凌玲[1] 胡久叶[2] 杜晓莉[1] 周青敏 袁梅美 LING Ling;HU Jiu-ye;DU Xiao-li;ZHOU Qing-min;YUAN Mei-mei(Digestive Endoscopy Center,Affiliated Hospital of Xiangnan University,Chenzhou,Hunan,423000,China;Department of Digestive Internal,Affiliated Hospital of Xiangnan University,Chenzhou,Hunan,423000,China)

机构地区：[1]湘南学院附属医院消化内镜中心,湖南郴州423000 [2]湘南学院附属医院消化内科,湖南郴州423000

出　　处：《现代生物医学进展》2020年第5期966-970,991,共6页Progress in Modern Biomedicine

基　　金：湖南省临床医疗技术创新引导项目(2018SK52002)。

摘　　要：目的:探讨梗阻性黄疸患者经内镜逆行胰胆管造影(ERCP)术后胆道感染病原菌分布、耐药性以及导致术后胆道感染的影响因素。方法:选择2016年3月至2019年10月我院收治的310例行ERCP治疗的梗阻性黄疸患者,根据ERCP术后是否发生胆道感染将其分为感染组(50例)和未感染组(260例)。检测胆道感染患者病原菌种类及其耐药性,多元Logistic回归分析影响梗阻性黄疸患者ERCP术后胆道感染的影响因素。结果:ERCP术后胆道感染发生率为16.13%,大肠埃希菌、铜绿假单胞菌、粪肠球菌、屎肠球菌是主要致病菌,检出率分别为40.79%、13.16%、9.21%、6.58%。大肠埃希菌、铜绿假单胞菌对头孢类、氨基糖苷类抗生素耐药率高,粪肠球菌、屎肠球菌对利福平、喹诺酮类抗生素耐药率高,大肠埃希菌、铜绿假单胞菌、粪肠球菌、屎肠球菌均对利奈唑胺、亚胺培南敏感。多元Logistic回归分析结果显示,恶性病变、ERCP2次及以上、胆胰管汇流异常、术后胆管引流不畅是梗阻性黄疸患者ERCP术后胆道感染的危险因素(P<0.05),术后预防性使用抗生素是保护因素(P<0.05)。结论:梗阻性黄疸患者ERCP术后存在一定胆道感染风险,革兰氏阴性菌是主要致病菌,临床应注重对高危因素预防,有必要术后选择敏感抗生素预防性治疗。Objective: To investigate the distribution of pathogenic bacteria, drug resistance and influence factors of biliary tract infection in patients with obstructive jaundice after endoscopic retrograde cholangiopancreatography(ERCP). Methods: From March 2016 to October 2019, 310 patients with obstructive jaundice who received ERCP in our hospital were selected, and they were divided into the infected group(50 cases) and the uninfected group(260 cases) according to whether biliary tract infection occurred after ERCP.Pathogenic bacteria types and drug resistance of biliary tract infection patients were detected, and multiple Logistic regression analysis was performed to analyze the influence factors of biliary tract infection in patients with obstructive jaundice after ERCP. Results: The incidence of biliary tract infection after ERCP was 16.13%, escherichia coli, pseudomonas aeruginosa, enterococcus faecalis and enterococcus faecium were the main pathogenic bacteria, and the detection rate were 40.79%, 13.16%, 9.21% and 6.58%, respectively.Escherichia coli and pseudomonas aeruginosa had high drug resistance to cephalosporins and aminoglycosides, while enterococcus faecalis and enterococcus faecium had high drug resistance to rifampicin and quinolones. Escherichia coli, pseudomonas aeruginosa,enterococcus faecalis and enterococcus faecium were all sensitive to linzolid and imipenem. Multiple Logistic regression analysis showed that malignant lesion, two or more time ERCP, abnormal biliary duct confluence and postoperative obstruction of bile duct drainage were risk factors for biliary tract infection in patients with obstructive jaundice after ERCP(P<0.05). Postoperative prophylactic use of antibiotics was a protective factor(P<0.05). Conclusion: Obstructive jaundice patients after ERCP have a certain risk of biliary tract infection, gram negative bacteria are the main pathogens, clinical attention should be paid to the prevention of high-risk factors, it is necessary to choose postoperative sensitive antibiotic preven

关 键 词：梗阻性黄疸 经内镜逆行胰胆管造影 胆道感染 病原菌 耐药性 影响因素 

分 类 号：R657.4[医药卫生—外科学]