摘要
目的对胆道恶性梗阻患者胆汁病原菌的菌群分布、临床常用抗菌药物的敏感性及有关因素进行分析,为胆道感染抗菌药物的合理应用提供参考。方法 2008年5月～2011年8月,92例行ERCP或PTCD的胆道恶性梗阻患者,ERCP术中插管成功并确认进入胆道或PTCD术中用22G穿刺针行胆管穿刺成功确认在胆管内后,抽取胆汁进行细菌学培养和抗菌药物敏感性检测,分析细菌谱与梗阻的部位、程度等有关因素的关系。结果 92例胆道恶性梗阻共送检124份胆汁。90份细菌培养阳性胆汁中,胆道感染的主要病原菌为肠球菌属(24.4%,22份)、大肠埃希菌(18.9%,17份)、肺炎克雷伯菌(7.8%,7份)、铜绿假单胞菌(5.6%,5份)。革兰阳性球菌对万古霉素和利奈唑胺的敏感率均为100%(37/37),对呋喃妥因、夫西地酸和左氧氟沙星的敏感率分别为73.0%(27/37)、45.9%(17/37)和37.8%(14/37);革兰阴性杆菌对亚胺培南、阿米卡星、哌拉西林/他唑巴坦、头孢吡肟和左氧氟沙星的敏感率分别为93.8%(45/48)、85.4%(41/48)、68.8%(33/48)、39.6%(19/48)、33.3%(16/48)。大肠埃希菌的超广谱β-内酰胺酶(ESBL)的阳性率为64.7%(11/17),肺炎克雷伯菌为42.9%(3/7)。中低位梗阻细菌培养阳性率为49.0%(25/51),高位梗阻为85.4%(35/41)(χ2=13.236,P=0.000)。血总胆红素水平低(20.2～171μmol/L)、中(172～342.1μmol/L)、高水平(≥342.1μmol/L)细菌培养阳性率分别为74.4%(29/39)、62.5%(25/40)、46.2%(6/13)(χ2=3.650,P=0.161)。结论胆道恶性梗阻患者的胆道感染以肠球菌属占首位,且高位恶性梗阻的患者细菌培养阳性率高。因此,对恶性梗阻性胆道感染的治疗,应尽早解除胆道梗阻,并根据药物敏感性选择合适的抗生素,尤其要注意考虑到覆盖肠球菌属。
Objective To study the pattern of pathogen strains and their resistance to antimicrobial agents and to analyse the related factors in patients with malignant biliary obstruction for rational antimicrobial chemotherapy. Methods Ninety-two patients with malignant biliary obstruction received ERCP or PTCD drainage between May 2008 and August 2011. The bile samples were cultured to detect bacterial occurrence and screen antibiotic sensitivities after ERCP or PTCD （22G needle） , and to analyse the relationship between bacteria spectrum and the location of biliary obstruction. Results There were totally 124 bile samples harvested from the 92 patients. The most common organism of the 90 bile samples which culture results were positive was Enterocoecus （24.4% , 22/90）, followed by E. Coli （ 18.9% ,17/90）, Klebsiella Pneumoniae （7.8% ,7/90） and Pseudomonas Aeruginosa （5.6% ,5/90）. None of Gram positive strains were resistant to vancomyein and tinezotid. The sensitivity rate of Gram negative strains to imipenem was 93.8% （45/48）, followed by amikacin （85.4% ,41/48）, piperacillin and tazobactam （68.8% ,33/48）, cefepime hydrochloride （39.6% ,19/48） and levofloxaein （33.3% , 16/48）. The rate of ESBL-producing bacteria in Eseherichia coli isolates was 64.7% （11/17）. The rate of ESBL-producing bacteria in Klebsiella Pneumoniae was 42.9% （3/7）. The detecting rate in medium and low obstruction patients was 49.0% （25/51） and that in high obstruction patients was 85.4% （35/41） （χ2 = 13. 236, P = 0. 000）. The bacteria detecting rate was 74.4% （29/39） for the patients with low level of bilirubin （20.2 - 171 μmol/L）, it was 62.5% （25/40） for the patients with median level of bilirubin （ 172 - 342.1 μmol/L）, and 46.2% （6/13） for the patients with high level of bilirubin （ ≥342.1 μmol/L; χ2= 3. 650, P = 0. 161 ）. Conclusions Enterococcus has been found more common in patients with malignant hiliary obstruction. Antibiotic treatment combined with biliary decompression as early as possib）e is suggested for biliary obstructive infection,especially for those patients with porta hepatis obstruction. After biliary decompression, antibiotics shall be selected according to the results of susceptibility test.
出处
《中国微创外科杂志》
CSCD
2011年第12期1116-1120,共5页
Chinese Journal of Minimally Invasive Surgery
关键词
胆道恶性梗阻
感染
病原菌
耐药性
Malignant biliary obstruction
Infection
Pathogen
Resistance
