晚期恶性梗阻性黄疸支架置入术后感染的细菌学分析

Bacteria spectrum analysis of postoperative infection in advanced malignant obstructive jaundice after biliary drainage

目的:分析恶性梗阻性黄疸内镜下胆道支架置入内引流术(ERBD)或经皮肝穿刺胆道引流术(PTCD)后胆系感染的细菌谱。方法 :恶性梗阻性黄疸患者193例,根据胆管梗阻情况分别施行ERBD或PTCD。对围手术期的胆道感染,进行血及胆汁细菌培养。术后进行6个月的随访,对再次发生胆道感染的患者,同样进行血或胆汁细菌培养。结果:围手术期;术前合并胆系感染者98例(50.77%),术后新发胆系感染10例(5.18%)。术后随访:6个月内发生1次感染者104例,其中25例反复发生胆系感染。血培养显示术前胆道感染的主要致病菌为大肠埃希菌、肺炎克雷伯菌等及粪肠球菌。术后、围手术期及随访期内血或胆汁培养显示主要为大肠埃希菌、铜绿假单胞菌等及粪肠球菌、产青霉素酶的金黄色葡萄球菌(MRSA)等革兰阳性菌,ESBLs菌株明显增多。结论:胆系感染是晚期恶性梗阻性黄疸及行ERBD或PTCD术后最常见的并发症,了解晚期恶性梗阻性黄疸及行ERBD或PTCD术后胆系感染的细菌谱,有助于合理选择有效抗生素并及时有效的控制感染。

Objective To analyze the bacteria spectrum of postoperative infection in advanced malignant obstructive jaundice after endoscopic retrograde biliary drainage（ERBD） or percutaneous transhepatic biliary drainage（PTCD）.Methods 193 patients with advanced malignant obstructive jaundice were treated by ERBD or PTCD according to the extent of bile duct obstruction.Blood and / or bile germiculture were performed for reason of perioperative infection of biliary tract.Postoperative follow up was continued for 6 months.Blood and / or bile germiculture were performed for patients with recurrent biliary tract infection.Results 98 cases（50.77%） developed biliary tract infection before the operation,new infection was found in 10 cases（5.18%） after the operation.104 cases developed biliary tract infections once during 6 months of follow-up,within whom 25 cases developed recurrent biliary tract infection.Blood germiculture results indicated that the predominant pathogenic bacteria before operation were Gram negative Enterobacteria,including Escherichia coli,klebsiella pneumoniae,and Enterococcus faecalis.Blood and / or bile germiculture results indicated that the predominant pathogenic bacteria after operation were Gram negative Enterobacteria,including Escherichia coli,Pseudomonas aeruginosa,and Gram positive bacteria,including Enterococcus faecalis,MRSA.ESBLs strains were significantly increased after operation and during the follow-up period.Conclusion The biliary tract infection is the most common complication in advanced malignant obstructive jaundice after biliary drainage.To investigate the bacteria spectrum of biliary tract infections of advanced malignant obstructive jaundice after biliary drainage may help to select antibiotics rationally and to eliminate infections effectively.