恶性胆道梗阻病因与胆汁病原菌及耐药性的相关性分析  

Correlation analysis of the etiology of malignant biliary obstruction with biliary pathogens and drug resistance

作　　者：高群[1] 马莉[2] 曹彬[1] 祝振明 黄颖慧 乔小路 王蕾[1] 何宝国[1] GAO Qun;MA Li;CAO Bin;ZHU Zhenming;HUANG Yinghui;QIAO Xiaolu;WANG Lei;HE Baoguo(Department of Gastroenterology,the Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Clinical Nutrition,the Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属医院消化内科,266000 [2]青岛大学附属医院临床营养学科,266000

出　　处：《现代消化及介入诊疗》2024年第12期1414-1418,共5页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：山东省自然科学基金项目(ZR2021MH348)。

摘　　要：目的 本研究旨在回顾性地分析不同病因下恶性胆道梗阻患者胆汁病原菌分布和药敏试验结果,为临床治疗提供参考依据。方法 收集2015年11月至2023年4月于我院就诊的228例恶性胆道梗阻胆汁培养阳性患者的临床资料,比较不同病因下患者胆汁标本的细菌培养、菌株种类鉴定以及药敏检测结果,分析胆汁病原菌分布以及耐药性的差异。结果 恶性胆道梗阻患者胆道感染以革兰阳性菌为主(64.74%),其中胆管癌(54.22%)、十二指肠乳头癌(64.15%)患者革兰阴性菌感染率更高,肝癌(64.29%)、胰头癌(53.97%)患者革兰阳性菌感染率更高。主要病原菌为大肠埃希菌(14.21%)、肺炎克雷伯菌(13.11%)、屎肠球菌(11.75%)和表皮葡萄球菌(7.65%)。胆管癌的大肠埃希菌感染率以及肝癌的表皮葡萄球菌感染率明显高于其他三组(P=0.002,P<0.001)。对革兰阴性菌耐药率低于15%的抗生素包括哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、亚胺培南、厄它培南、替加环素、阿米卡星;对革兰阳性菌耐药率低于10%的抗生素包括替加环素、万古霉素、利奈唑胺。头孢曲松对胰头癌患者病原菌的耐药率低于其他组(P=0.018),青霉素对肝癌患者病原菌的耐药率则高于其他组(P=0.003)。结论 不同病因的恶性胆道梗阻患者之间,其胆汁病原菌分布和耐药性存在差异,肝癌、胰头癌革兰阳性菌感染率更高,胆管癌、十二指肠乳头癌革兰阴性菌感染率更高,临床上可以根据恶性胆道梗阻的病因选择合适的抗生素进行早期经验性治疗。替加环素或许会成为治疗恶性胆道梗阻胆道感染的潜在初始药物。Objective This study aimed to retrospectively analyze the distribution of bile pathogens and their antibiotic resistance patterns in patients with malignant biliary obstruction under different etiologies,providing a reference for clinical treatment.MethodsClinical data of 228 patients with positive bile culture of malignant biliary obstruction who were admitted to our hospital from November 2015 to April 2023 were collected,and the results of bacterial culture,strain identification,and drug sensitivity testing of bile specimens from patients with different etiologies were compared to analyze the differences in the distribution of bile pathogenic bacteria and drug resistance.Results Biliary infections in patients with malignant biliary obstruction were dominated by gram-positive bacteria(64.74%),with higher rates of gram-negative bacteria in patients with cholangiocarcinoma(54.22%) and duodenal papillary carcinoma(64.15%),and gram-positive bacteria in patients with hepatocellular carcinoma(64.29%) and pancreatic head carcinoma(53.97%).The main pathogenic bacteria were Escherichia coli(14.21%),Klebsiella pneumoniae(13.11%),Enterococcus faecalis(11.75%) and Staphylococcus epidermidis(7.65%).The prevalence of Escherichia coli infection in cholangiocarcinoma as well as Staphylococcus epidermidis infection in hepatocellular carcinoma was significantly higher than the other three groups(P=0.002,P<0.001).Antibiotics with less than 15% resistance to gram-negative bacteria included piperacillin/tazobactam,cefoperazone/sulbactam,imipenem,ertapenem,tigecycline,and amikacin;antibiotics with less than 10% resistance to gram-positive bacteria included tigecycline,vancomycin,and linezolid.Ceftriaxone had a lower rate of resistance to pathogenic bacteria in patients with pancreatic head cancer than in the other groups(P=0.018),while penicillin had a higher rate of resistance to pathogenic bacteria in patients with hepatocellular carcinoma than in the other groups(P=0.003).Conclusion There are differences in the distribution and r

关 键 词：恶性胆道梗阻 胆汁培养 病原菌分布 耐药性 

分 类 号：R575[医药卫生—消化系统]