经鼻胆管引流术后胆汁培养及药敏结果分析

Analysis of bile bacteria culture and antibiotic sensitivity after endoscopic nasobiliary drainage

目的对经鼻胆管引流术(ENBD)引流的胆汁培养阳性的细菌种类、比例及其药物敏感性进行分析,旨在指导胆道感染时正确选用抗生素。方法收集2013年1月至2013年4月在消化内科行经内镜逆行胰胆管造影(ERCP)后行ENBD的患者,对胆汁培养和药敏试验的结果作回顾性分析。结果 208例患者中,180例为良性疾病,28例为恶性疾病,共112例(53.8%)胆汁培养阳性。最常见的细菌为大肠埃希菌(46.8%)、屎肠球菌(15.9%)、肺炎克雷伯杆菌(10.3%)和奇异变形杆菌(4.8%)等。14例为多种微生物生长。无论患者疾病的良恶性、是否术前诊断急性胆管炎、是否术前已使用抗生素,其胆汁培养阳性率差异均无统计学意义(58.9%比71.4%,51.7%比67.9%,54.5%比52.9%,P>0.05)。有无胆道手术史患者,其胆汁培养阳性率差异有统计学意义(87.0%比49.7%,P<0.01)。革兰阴性菌对泰能等敏感,革兰阳性菌对万古霉素等敏感。结论胆道手术史(包括ERCP及胆肠吻合)是胆道细菌生长的危险因素之一。胆道微生物的种类及药物敏感性,为临床经验性抗感染药物的选择提供了有力的依据。

Objective To identify the strain and frequency of microorganisms growth in bile which aspirated by endoscopic nasobiliary drainage （ENBD） and their antibiotic susceptibility, in order to guide anti-infective therapy. Methods This retrospective study included patients treated by encoscopic retrograde cholangio-pancreatography （ERCP） from January to April, 2013. The results of the cultivation and antibiotic sensitive test of bile were analysed. Results 208 cases were included in the study, of which 180 cases have benign disease, while 28 cases have malignant disease. The bile culture was positive for bacterial growth in 112 cases （53.8%）. The most frequently encountered organisms were Escherichia coli （46.8%）, Enterococcus faecium （ 15. 9%）, Klebsiella pneumoniae （ 10. 3%） and Proteus mirabilis （4.8%）. Fourteen cases were co-infection. The positive rate of bile culture had no significant differences between patients with malignant or benign disease, patients with acute cholangitis or without acute cholangitis, patients who were treated by antibiotics before ERCP or not （58.9% vs. 71.4%, 51.7% vs 67.9%, 54.5% vs. 52.9%, P〈0.05）. The positive rate of bile culture had significant differences between patients with or without biliary tract surgery （87.0% vs. 49.7%, P〈0.01）. Conclusions The biliary tract surgery （inculding ERCP and eholangioenterostomy） is one of the risk factors for microorganisms colonization in bile. The strain and frequency of microorganisms growth in bile culture and the antibiotic susceptibility would provide guidance to the selection of antibiotic for cholangitis.