急性胆道感染患者PTCD或ERCP术后胆汁细菌培养的变化及特点分析

Analysis of changes and characteristics of bile bacterial cultures in patients with acute biliary tract infection after a PTCD or ERCP procedure

目的研究分析胆总管结石患者合并胆道感染后,经内镜逆行胰胆管造影术(ERCP)或经皮肝胆管穿刺引流术(PTCD)术中、术后胆汁细菌培养的变化及分布等特点。方法选取2019年1月至2021年12月佛山市高明区人民医院普外科收治的胆道结石、胆道梗阻合并感染的患者,行ERCP 130例、PTCD 20例,分别术前进行血培养,以及取术中、术后48 h的胆汁进行细菌培养及药敏试验。结果共收集150例患者的临床资料。术前血培养阳性率为17.33%,患者术中、术后48 h胆汁培养阳性率分别为59.33%、18.67%,患者胆汁培养阳性率随时间下降。术前血培养阳性患者所感染细菌与术中、术后48 h胆汁培养阳性患者结果一致,检出的细菌主要为肺炎克雷伯菌等细菌、大肠埃希菌等阴性杆菌。结论胆道梗阻合并感染患者要尽早行ERCP取石引流或者PTCD引流解除胆道梗阻,感染主要细菌为阴性杆菌。胆汁细菌培养的结果明显高于血培养,对指导抗生素的使用,有着重要的指导意义。

Objective To study and analyze the characteristics such as changes and distribution of bile bacterial cultures during and after endoscopic retrograde cholangiopancreatography(ERCP)or percutaneous hepatobiliary drainage(PTCD)for patients with choledocholithiasis complicated with biliary tract infection.Methods Patients with biliary stones and biliary obstruction combined with infection admitted to the General Surgery Department of Foshan Gaoming District People’s Hospital from January 2019 to December 2021 were selected,including 130 patients who received ERCP and 20 patients who received PTCD.A preoperative blood culture test was performed,and bile samples were collected during and 48 hours after the operation for bacterial culture and drug sensitivity testing.Results Clinical data from 150 patients were collected.The positive rate in preoperative blood cultures was 17.33%,and the positive rates in bacterial culture during and 48 hours after the operation were 59.33%and 18.67%,respectively.The positive rate of bile decreased over time.The infection of bacteria in patients with positive preoperative blood culture is consistent with the results of patients with positive bile culture during and 48 hours after surgery.The bacteria detected were mainly bacteria such as Klebsiella pneumoniae and gram-negative bacilli such as Escherichia coli.Conclusion For patients with biliary obstruction combined with infection,ERCP stone removal and drainage or PTCD drainage shall be performed as early as possible to relieve the biliary obstruction.The main infection bacteria are gram-negative bacilli.The results of bile bacterial cultures are significantly higher than those of blood cultures,which have important significances for guiding the use of antibiotics.