胆总管结石合并胆道感染患者胆汁细菌谱和耐药性变异分析  

Analysis of bacterial spectrum and variability of drug resistance of bile in patients with common bile duct stones and biliary tract infections

作　　者：张航 綦鹏 谢丛 孟毓珊 薛魁金[1] 刘璐[1,2] 王光荣 刘婉婷 何宝国 鞠辉[1] 曹彬[1] Zhang Hang;Qi Peng;Xie Cong;Meng Yushan;Xue Kuijin;Liu Lu;Wang Guangrong;Liu Wanting;He Baoguo;Ju Hui;Cao Bin(Department of Gastroenterology,the Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Medicine,Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属医院消化内科,青岛266000 [2]青岛大学医学部,青岛266000

出　　处：《中华消化杂志》2023年第1期24-30,共7页Chinese Journal of Digestion

基　　金：青岛西海岸新区2020年度科技惠民专项项目(2020-58)。

摘　　要：目的分析胆总管结石合并胆道感染患者胆汁培养病原菌分布,以期指导临床优化抗生素的应用。方法选择2017年3月30日至2021年12月31日在青岛大学附属医院行经内镜逆行胆胰管造影术治疗的753例胆总管结石合并胆道感染患者,抽取胆汁进行细菌培养、菌株种类鉴定和药敏试验,分析胆汁病原菌的分布、变化趋势和耐药情况。采用卡方检验进行统计学分析。结果2017至2021年,753例胆总管结石合并胆道感染患者的胆汁培养总阳性率为90.17%(679/753)。2017至2021年胆汁培养阳性率分别为82.05%(64/78)、88.81%(119/134)、88.03%(125/142)、93.87%(199/212)、91.98%(172/187),各年份间的胆汁培养阳性率比较,差异有统计学意义(χ^(2)=10.78,P=0.029);2017年胆汁培养阳性率低于2020和2021年,差异均有统计学意义(χ^(2)=9.43、5.57,P=0.002、0.018);其余年份间胆汁培养阳性率比较,差异均无统计学意义(均P>0.05)。胆汁培养结果呈阳性的679份胆汁标本中,共检出病原菌1033株;革兰氏阴性杆菌总占比为57.02%(589/1033),2017至2021年的占比分别为66.38%(77/116)、66.47%(111/167)、59.43%(104/175)、54.75%(173/316)、47.88%(124/259);革兰氏阳性球菌总占比为41.05%(424/1033),2017至2021年的占比分别为31.90%(37/116)、31.74%(53/167)、38.86%(68/175)、44.30%(140/316)、48.65%(126/259);真菌总占比为1.94%(20/1033),2017至2021年的占比分别为1.72%(2/116)、1.80%(3/167)、1.71%(3/175)、0.95%(3/316)、3.47%(9/259)。2017至2021年,胆汁培养阳性的病尿菌中革兰氏阴性杆菌的占比逐渐降低,而革兰氏阳性球菌的占比逐渐升高,差异均有统计学意义(χ^(2)=20.14、17.91,P<0.001、=0.001);2017至2021年真菌的占比比较,差异无统计学意义(P>0.05)。胆汁培养致病菌中主要的革兰氏阴性杆菌为大肠埃希菌(31.36%,324/1033)、肺炎克雷伯菌(12.68%,131/1033);主要的革兰氏阳性球菌为屎肠球菌(14.04%,145/1033)、唾液链球菌(4.36%,45/1033)。Objective To analyze the distribution of pathogenic bacteria in bile culture in patients with common bile duct stones and biliary tract infections,in order to guide clinical optimization of antibiotics application.Methods From March 30,2017 to December 31,2021,at Affiliated Hospital of Qingdao University,753 patients with common bile duct stones and biliary tract infections and received endoscopic retrograde cholangiopancreatography were selected.Bile samples were obtained for bacterial culture,strain type identification and drug sensitivity test in order to analyze bile pathogenic bacteria distribution,change trend and drug resistance.Chi-square test was used for statistical analysis.Results From 2017 to 2021,the total positive rate of bile culture in 753 patients with choledocholithiasis complicated with biliary tract infection was 90.17%(679/753).From 2017 to 2021,the positive rates of bile culture were 82.05%(64/78),88.81%(119/134),88.03%(125/142),93.87%(199/212),and 91.98%(172/187),respectively,and the difference was statistically significant(χ^(2)=10.78,P=0.029).The positive rate of bile culture in 2017 was lower than those in 2020 and 2021,and the differences were statistically significant(χ^(2)=9.43 and 5.57,P=0.002 and 0.018).There were no significant differences in the positive rates of bile culture among the other years(all P>0.05).A total of 1033 pathogenic bacteria were detected in the 679 bile specimens with positive bile culture results.Among which the total proportion of Gram-negative bacilli was 57.02%(589/1033),and from 2017 to 2021 the proportions were 66.38%(77/116),66.47%(111/167),59.43%(104/175),54.75%(173/316),and 47.88%(124/259),respectively.The total proportion of Gram-positive cocci was 41.05%(424/1033),and from 2017 to 2021 the proportions were 31.90%(37/116),31.74%(53/167),38.86%(68/175),44.30%(140/316),and 48.65%(126/259),respectively.The total proportion of fungus was 1.94%(20/1033),and from 2017 to 2021 the proportions were 1.72%(2/116),1.80%(3/167),1.71%(3/175),0.95%(3/316),and 3

关 键 词：胆汁培养 病原菌 经内镜逆行胆胰管造影术 胆总管结石 胆道感染 

分 类 号：R575.62[医药卫生—消化系统] R446.5[医药卫生—内科学]