肝门部胆管癌患者射频消融联合金属支架植入治疗后胆道感染病原菌及其危险因素  

Pathogenic bacteria of biliary tract infection and their risk factors in patients with hilar cholangiocarcinoma after radiofrequency ablation combined with metallic stent implantation

作　　者：张晓辉[1] 李明莉 张小红[2] 刘伟峰[1] 梁建红[3] ZHANG Xiao-hui;LI Ming-li;ZHANG Xiao-hong;LIU Wei-feng;LIANG Jian-hong(Jinghua Hospital,the First Affiliated Hospital of Henan University of Scienceand Technology,Luoyang,Henan 471003,China)

机构地区：[1]河南科技大学第一附属医院景华院区肝胆外科,河南洛阳471003 [2]河南科技大学第一附属医院开元院区肝胆外科,河南洛阳471000 [3]河南科技大学第一附属医院感染防控部,河南洛阳471003

出　　处：《中华医院感染学杂志》2023年第4期552-556,共5页Chinese Journal of Nosocomiology

基　　金：河南省医学科技攻关计划联合共建基金资助项目(LHGJ20191290)。

摘　　要：目的 探讨肝门部胆管癌(HCCA)患者射频消融(RFA)联合金属支架植入治疗后胆道感染病原菌情况,分析其危险因素并构建预测模型.方法 选择2019年1月-2021年1月河南科技大学第一附属医院诊治的86例HCCA患者,均行RFA联合金属支架植入治疗,采集胆汁标本行病原菌监测及药敏试验,同时分析HCCA治疗后胆道感染的危险因素并构建预测模型.结果 治疗后胆道感染发生率为22.09%(19/86);HCCA治疗后胆道感染患者胆汁培养液检出病原菌27株,革兰阴性菌17株占62.96%,革兰阳性菌9株占33.33%,真菌1株占3.70%,以大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌为主;治疗前未预防性使用抗菌药物、治疗前白蛋白是HCCA治疗后胆道感染的危险因素(P<0.05);危险因素构建的预测模型评估HCCA治疗后胆道感染发生风险的曲线下面积为0.947,敏感性、特异性分别为89.30%、95.10%.结论 HCCA患者RFA联合金属支架植入治疗后胆道感染发生风险高,革兰阴性菌为其主要致病菌,治疗前未预防性使用抗菌药物、治疗前白蛋白是HCCA患者治疗后胆道感染的危险因素,建立预测模型可为临床监测感染高危人群提供依据.OBJECTIVE To investigate the pathogenic bacteria of biliary tract infection in patients with hilar cholangiocarcinoma(HCCA)after radiofrequency ablation(RFA)combined with metallic stent implantation,and to analyze its risk factors and construct a prediction model.METHODS Totally 86 patients with HCCA treated at the First Affiliated Hospital of Henan University of Science and Technology from Jan.2019 and Jan.2021 were selected,all of whom were treated with RFA combined with metallic stent implantation,bile specimens were collected for pathogenic bacteria monitoring and drug sensitivity testing,while the risk factors of biliary tract infection after HCCA treatment were analyzed,and a prediction model was constructed.RESULTS After treatment,the incidence of biliary tract infection was 22.09%(19/86).A total of 27 pathogenic bacteria strains were detected from bile culture solution of patients with biliary tract infection after HCCA treatment,with 17 strains of Gram-negative bacteria accounting for 62.96%,9 strains of Gram-positive bacteria accounting for 33.33%,and 1strain of fungus accounting for 3.7o%,and with Escherichia coli,Pseudomonas aeruginosa and Staphylococcus aureus as the main strains.Failure to use antibacterial drugs prophylactically and albumin level before treatment were risk factors of biliary tract infection in patients after HCCA treatment(P<0.05).The area under the curve of the prediction model constructed based on the risk factors to predictive the risk probability of biliary tract infection after treatment for HCCA was 0.947,with sensitivity and specificity of 89.30%and 95.10%,respectively.CONCLUSION Patients with HCCA had a high risk of biliary tract infection after RFA combined with metallic stent implantation,and Gram-negative bacteria were the main pathogenic bacteria.Pre-treatment failure to use antimicrobials prophylactically and pre-treatment albumin were risk factors for post-treatment biliary tract infection in patients with HCCA,and the establishment of a prediction model might provide

关 键 词：肝门部胆管癌 射频消融 金属支架植入 胆道感染 病原菌 预测模型 危险因素 

分 类 号：R575.7[医药卫生—消化系统]