内镜逆行胰胆管造影术后胆道感染病原学及危险因素  

Etiological characteristics and risk factors for postoperative biliary tract infection in patients undergoing endoscopic retrograde cholangiopancreatography

作　　者：张佩[1] 余明红[2] 何丽波 周芬[3] 张俊玲[4] 张龙[5] ZHANG Pei;YU Ming-hong;HE Li-bo;ZHOU Fen;ZHANG Jun-ling;ZHANG Long(Hanchuan People′s Hospital,Hanchuan,Hubei 431600,China)

机构地区：[1]汉川市人民医院感染疾病科,湖北汉川431600 [2]汉川市人民医院皮肤科,湖北汉川431600 [3]汉川市人民医院护理部,湖北汉川431600 [4]汉川市人民医院全科医学科,湖北汉川431600 [5]汉川市人民医院中西医结合外科,湖北汉川431600

出　　处：《中华医院感染学杂志》2022年第22期3438-3442,共5页Chinese Journal of Nosocomiology

基　　金：湖北省科研基金资助项目(2020G0210)。

摘　　要：目的探讨内镜逆行胰胆管造影(ERCP)术后胆道感染病原学及危险因素。方法选取2018年5月-2020年10月汉川市人民医院收治的182例行ERCP患者为研究对象,根据ERCP术后是否发生胆道感染分为胆道感染组37例和非感染组145例。比较两组患者临床资料,采用Logistic回归分析术后胆道感染的危险因素,并采集胆道感染组患者的胆汁进行细菌培养、药敏试验、检测细菌耐药基因分型。结果胆道感染组患者中胆道高位梗阻、ERCP手术时间>1 h、术后胆汁引流不畅、伴随Oddi括约肌功能障碍、十二指肠乳头旁憩室的比例高于非感染组,ERCP术后预防性使用抗菌药物比例低于非感染组(P<0.05);多因素Logistic回归分析显示,胆道高位梗阻、伴随Oddi括约肌功能障碍及十二指肠乳头旁憩室是ERCP术后感染的危险因素(P<0.05);共检出44株病原菌中大肠埃希菌23株,占比最高为52.27%,其中产超广谱β-内酰胺酶(ESBLs)菌18株,不产ESBLs菌5株,两者对β-内酰胺类、喹诺酮类的耐药性差异有统计学意义(P<0.05),两者对碳青霉烯类均完全敏感。产ESBLs以及不产ESBLs菌株的耐药基因型差异有统计学意义(P<0.05)。结论ERCP术后胆道感染的主要致病菌为大肠埃希菌,产ESBLs大肠埃希菌呈多药耐药趋势,耐药基因型以blaTEM、blaCTX-M为主,临床应注重对高危因素的预防。OBJECTIVE To explore the risk factors for postoperative biliary tract infection in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP)and observe the etiology and drug resistance genes.METHODS A total of 182 patients who underwent ERCP in Hanchuan People′s Hospital from May 2018 to Oct 2020 were recruited as the study subjects and divided into the biliary tract infection group with 37 cases and the non-infection group with 145 cases according to the status of biliary tract infection after ERCP.The clinical data were compared between the two groups of patients.Logistic regression analysis was carried out for risk factors for the postoperative biliary tract infection,the bile specimens were collected from the patients with biliary tract infection so as to conduct the bacterial culture,the drug susceptibility testing was performed,and the genotypes of drug resistance genes were identified.RESULTS The proportions of patients with upper biliary tract obstruction,duration of ERCP more than 1 hour,poor bile drainage after surgery,Oddi sphincter dysfunction and paraduodenal diverticula were higher in the biliary tract infection group than in the non-infection group,while the proportion of patients who were treated with antibiotics prophylaxis after ERCP was lower in the biliary tract infection group than in the non-infection group(P<0.05).Multivariate logistic regression analysis showed that the upper biliary tract obstruction,Oddi sphincter dysfunction and paraduodenal diverticula were the risk factors for postoperative infection in the patients undergoing ERCP(P<0.05).Totally 44 strains of pathogens were isolated,23(52.27%)of which were Escherichia coli,including 18 strains of extended-spectrumβ-lactamases(ESBLs)-producing E.coli and 5 strains that did not produced ESBLs.There were significant differences in the drug resistance rates toβ-lactams and quinolones between the two(P<0.05);both were completely sensitive to carbapenems.There were significant differences in the drug resistance genotype

关 键 词：内镜逆行胰胆管造影 胆道感染 病原学 危险因素 大肠埃希菌 药敏试验 耐药基因 

分 类 号：R657.4[医药卫生—外科学]