胆总管结石合并胆道感染患者胆汁病原菌分布及其耐药性分析  

Distribution and antibiotic resistance analysis of pathogenic bacteria in bile cultures from 105 patients with common bile duct stones and biliary tract infections

作　　者：贾莉 赵华才 杨兴萍 刘佳[4] JIA Li;ZHAO Hua-cai;YANG Xing-ping;LIU Jia(Department of Infection Control,Dayi People’s Hospital,Chengdu,Sichuan 611330,China;Department of Urology,Dayi People’s Hospital,Chengdu,Sichuan 611330,China;Inspection Department of China 19th Metallurgical Group Co.,Ltd.Employee Hospital,Panzhihua 617023,China;Department of Infection Control,Fifth People’s Hospital of Chengdu,Sichuan 611130,China)

机构地区：[1]四川省成都市大邑县人民医院院感科,611330 [2]四川省成都市大邑县人民医院泌尿外科,611330 [3]中国十九冶集团有限公司职工医院检验科 [4]成都市第五人民医院院感科

出　　处：《肝脏》2024年第7期848-851,共4页Chinese Hepatology

基　　金：四川省科技计划项目(2021YJ0468)。

摘　　要：目的探究胆总管结石合并胆道感染患者的胆汁病原菌分布和耐药性。方法选取中国十九冶集团职工医院2019年6月至2023年1月收治的胆道感染的胆总管结石患者105例。根据结石的情况将患者分为初发组和复发组。收集受试者的一般资料,包括性别、年龄、临床表现、实验室检查结果及影像学检查结果等。使用VITEK 2 Compact全自动菌种分析仪分离鉴定胆汁中的菌株。使用纸片琼脂扩散法进行药物敏感试验。观察受试者的抗生素使用史,胆汁菌株培养的阳性率、分布情况,胆汁中细菌的耐药情况等。结果结石初发组55例,复发组50例。与复发组相比,初发组的抗生素使用率更高(P<0.05)。初发组和复发组的胆汁培养阳性率分别为83.6%(46/55)和94.0%(47/50),差异有统计学意义(χ^(2)=-3.923,P=0.001)。复发组革兰阴性菌为84.0%(36/50),大肠埃希菌为30.0%(15/50)高于初发组的63.6%(13/55)和23.6%(13/55),差异有统计学意义(P<0.05)。其他病原菌分布初发组和复发组差异无统计学意义(P>0.05)。与初发组相比,病原菌耐药率在复发组中明显增高,耐药性明显增强有大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌(P<0.05)。结论初发和复发胆总管结石合并胆道感染患者的病原菌分布相似,但复发组的病原菌耐药性高于初发组,临床医生用药应根据患者结石复发情况、耐药实验慎重选择抗生素。Objective To investigate the distribution and drug resistance of pathogenic bacteria in 105 patients with common bile duct stones complicated by biliary tract infection.Methods A total of 105 patients admitted to our hospital from June 2019 to January 2023 were selected for the study,comprising 58 males and 47 females with an average age of(49.6±10.5)years.Based on the condition of the stones,the patients were divided into two groups:the initial group and the recurrent group.General information about the subjects,including gender,age,clinical presentation,laboratory test results,and imaging examination results,was collected.Endoscopic retrograde cholangiopancreatography(ERCP)was performed by experienced doctors using Olympus electronic duodenoscopy.Following the ERCP procedure,5-10ml of bile was collected through the nasobiliary duct.The collected bile samples were transferred into sterile test tubes and sent to our hospital laboratory for bacterial culture and analysis.The bile samples were cultured for 48-72 hours,after which the bacterial strains were isolated and identified using the VITEK 2 Compact fully automatic bacterial analyzer.Drug sensitivity tests on bacterial strains were performed using the paper agar diffusion method.The study observed the subject's history of antibiotic use,the positive rate and distribution of bile strain cultures,and the antibiotic resistance of the bacteria found in the bile.Results Based on the condition of the stones,there were 55 cases in the initial group and 50 cases in the recurrent group.,The initial group had a higher rate of antibiotic use,compared to the recurrence group(P<0.05).The positive rates of bile culture in the initial and recurrent groups were 83.6%and 94.0%,respectively,and the disfference was statistically significant(P<0.05).The recurrence group showed a significant increase in Gram-negative bacteria and Escherichia coli,compared to the initial group(P<0.05).There was no significant difference in the distribution of other pathogens between the initial a

关 键 词：胆总管结石 胆道感染 胆汁培养 病原菌分布 耐药性分析 

分 类 号：R575.62[医药卫生—消化系统]