恶性梗阻性黄疸患者胆道分离细菌药敏与感染的相关因素分析

Biliary tract infection and risk factors of patients with malignant obstructive jaundice

目的分析恶性梗阻性黄疸(malignant obstructive jaundice,MOJ)患者胆汁致病菌分布及药物敏感情况,探讨梗阻类型、腹部手术史、梗阻程度及时间等因素与致病菌感染的相关性。方法选取2015年1月至2016年3月在我院就诊的93例MOJ患者资料行回顾性分析,所有病例行经皮肝穿胆汁引流术(pertutaneous transhepatic biliary drainage,PTBD),术中收集胆汁行细菌培养及药物敏感测试,对胆汁培养阳性者行相关性分析。结果共送检93份胆汁,其中培养阳性60.2%(56/93),共检出58株致病菌株,其中革兰阳性菌占36.2%(21/58),革兰阴性菌占63.8%(37/58),致病菌中以肠球菌、大肠埃希菌、肺炎克雷伯菌及葡萄球菌属等多见。结论胆道感染以肠道菌群为主,应根据药物敏感结果及时调整治疗。相关性分析显示低位梗阻及有腹部外伤史为胆系感染相关因素,梗阻时间及程度则与胆系感染无相关性。

Objective To investigate the information obtained by bile culture and susceptibility testing as while factors like styles of obstruction, abdominal surgical history, degree and time of jaundice related to bacterial infection of biliary tract for patients with malignant obstructive jaundice （MOJ）. Methods A total of 93 patients with MOJ received pereutaneous transhepatic biliary drainage （PTBD） during Jan. , 2015 and Mar. , 2016. Bile specimens were collected during the procedure for bacterial culture and susceptibility. Results A rate of 60.2% （56/93） patients had a positive bile culture and 58 strains were identified, in which gram-positive bacteria accounted for 36.2% （21/58） and gram-negative bacteria accounted for 63.8 % （37/58）. The most common bacteria were Enterococcus Faecalis, Escherichia Coli , Klebsiella Pneumonia and Staphylococcus Epidermidis. Conclusions The bile cultures indicated that a different antibacterial therapy should be managed in the patients of biliary infection complicated by malignant biliary jaundice. Low obstruction and abdominal surgery history are independent factors related to infection, while time and degree of jaundice shows no relationship to infection.