恶性梗阻性黄疸患者PTCD术后胆道感染病原学与影响因素  

Etiological characteristics of biliary tract infections in patients with malignant obstructive jaundice after PTCD

作　　者：朱飚 傅建 朱翔宇[1] 宗方[2] ZHU Biao;FU Jian;ZHU Xiang-yu;ZONG Fang(Yiwu Central Hospital,Yiwu,Zhejiang 322000,China)

机构地区：[1]义乌市中心医院肝胆外科,浙江义乌322000 [2]义乌市中心医院超声科,浙江义乌322000

出　　处：《中华医院感染学杂志》2020年第23期3644-3648,共5页Chinese Journal of Nosocomiology

基　　金：浙江省自然科学基金资助项目(2019386)。

摘　　要：目的探究不同年龄梗阻性黄疸患者经皮肝穿刺胆道引流(PTCD)术后胆道感染现状、病原学特点及影响因素分析。方法选择2016年1月-2019年12月义乌市中心医院收治的恶性梗阻性黄疸PTCD患者作为研究对象,收集患者临床资料,进行胆汁菌株鉴定及耐药性分析,采用Logistic分析患者胆道感染的影响因素。结果 128例患者中35例(27.34%)患者诊断为胆道感染,共检出致病菌60株,其中革兰阴性菌48株占80.00%,以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌为主;革兰阳性菌10株占16.67%,以粪肠球菌为主;真菌2株占3.33%。60株致病菌中18株分离自≤60岁患者,26株分离自61~70岁患者,16株分离自71~80岁患者;不同年龄段病原菌构成情况差异无统计学意义。大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌对哌拉西林、头孢唑林、头孢克洛、头孢噻肟、环丙沙星等药物耐药性较强,对厄他培南、美罗培南、亚胺培南等药物敏感性较强。粪肠球菌对红霉素、四环素、环丙沙星及左氧氟沙星耐药性较强,未检出替考拉宁、万古霉素、利奈唑胺耐药菌株。Logistic多因素分析显示,年龄≥60岁、术前黄疸持续时间≥10 d、术前总胆红素≥300μmol/L、引流量<300 ml/d是胆道感染的独立危险因素(P<0.05)。结论胆道感染病原菌对多种药物均表现为较强的耐药性,临床宜结合病原菌耐药性进行用药;PTCD手术患者年龄、术前病情及术后引流情况与胆道感染均存在一定相关性,临床应根据这些危险因素进行早期预防及治疗,降低胆道感染发生风险。OBJECTIVE To investigate the situation, etiological characteristics and influencing factors of biliary tract infections in patients with obstructive jaundice in different age groups after percutaneous transhepatic cholangial drainage(PTCD). METHODS Patients with malignant obstructive jaundice treated with PTCD in Yiwu Central Hospital from Jan. 2016 to Dec. 2019 were enrolled as the research subjects. Patients′ clinical data were collected, and bile specimens were cultured for the strain identification and drug resistance analysis. The risk factors of biliary tract infections were analyzed by logistic analysis. RESULTS Thirty-five(27.34%) patients were diagnosed as biliary infections in all 128 patients. A total of 60 strains of pathogenic bacteria were detected, including 48 strains of Gram-negative bacteria(80.00%) which mainly included Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa, 10 strains of Gram-positive bacteria(16.67%) which mainly included Enterococcus faecalis, and 2 strains of fungi(3.33%). Of the 60 strains of pathogenic bacteria, 18 were isolated from patients ≤60 years old, 26 from patients between 61 and 70 years old, and 16 from patients between 71 and 80 years old, and there was no significant difference in the detection rates of bacteria among different age groups. E.coli, K pneumoniae and P.aeruginosa were highly resistant to piperacillin, cefazolin, cefaclor, cefotaxime and ciprofloxacin, and highly sensitive to ertapenem, meropenem and imipenem. E.faecalis was highly resistant to erythromycin, tetracycline, ciprofloxacin and levofloxacin. No teicoplanin, vancomycin, or linezolid resistant strains were detected. Multivariate logistic analysis showed that age ≥60 years old, preoperative jaundice duration ≥10 d, preoperative total bilirubin ≥300 μmol/L and drainage volume < 300 ml/d were independent risk factors of biliary tract infections(P<0.05). CONCLUSION The pathogenic bacteria associated with biliary tract infections are highly resistant to many drugs. Dru

关 键 词：梗阻性黄疸 经皮肝穿刺胆道引流 胆道感染 影响因素 

分 类 号：R619+.3[医药卫生—外科学]