胆道肠球菌感染患者炎症因子水平和病原菌分布及危险因素分析

Inflammatory factor levels, pathogenic distribution and related risk factors in patients with Enterococcus infection

目的讨论肠球菌感染患者炎症因子水平、病原菌分布及相关危险因素。方法选择2017年1月至2019年1月于咸宁市中心医院就诊的120例胆道肠球菌感染患者作为观察组,另选取同期120例未感染的健康体检者为对照组。对比两组对象血清炎症因子水平,分析观察组患者肠球菌种类分布及其耐药性,并分析胆道肠球菌感染的危险因素。结果观察组患者血清IL-6、IL-17、TNF-α水平明显高于对照组(P<0.05)。观察组患者病原菌以屎肠球菌、粪肠球菌和鸟肠球菌为主,分别占56.67%(68/120)、22.50%(27/120)和15.00%(18/120)。粪肠球菌对红霉素、喹奴普汀/达福普汀及利福平均表现出较强的耐药性,耐药率均大于50.00%。屎肠球菌对庆大霉素(高浓度)、链霉素(高浓度)、青霉素G、红霉素、氨苄西林、环丙沙星、左氧氟沙星、利福平均表现出较强的耐药性,耐药率均大于50.00%。鸟肠球菌对克林霉素、青霉素G、红霉素、环丙沙星、左氧氟沙星均表现出较强耐药性。既往有胆道手术史、胆结石、胰腺癌及既往存在ERCP操作和APACHEⅡ评分≥4均为胆道肠球菌感染的独立危险因素。结论胆道肠球菌感染患者会出现炎症因子水平升高的现象,其病原菌以屎肠球菌、粪肠球菌、鸟肠球菌为主,其中屎肠球菌对多种抗菌药物具有较高耐药率,应针对相关危险因素采用合理治疗方案,以尽可能降低患者感染率。

Objective To discuss the levels of inflammatory factors, pathogenic distribution and related risk factors in patients with Enterococci infection. Methods The clinical data of 120 patients with Enterococci infection who were treated in our hospital from January 2017 to January 2019(Observation group) and 120 healthy physical examinees during the same period(control group) were collected. The inflammatory factor levels in both groups were analyzed. The distribution and drug resistance of Enterococci and the risk factors associated with Enterococci infection in observation group were analyzed. Results The levels of serum IL-6, IL-17 and TNF-α in the observation group were significantly higher than those in the control group(all P<0.05). Enterococcus faecalis, Enterococcus faecalis and Enterococcus avian were the main pathogens in observation group, accounting for 56.67%(68/120), 22.50%(27/120) and 15.00%(18/120) respectively. Enterococcus faecalis showed strong resistance to Erythromycin, Quinupristin/Dalfoptin and Rifampin, and the resistance rates were higher than 50.00%. Enterococcus faecalis showed strong resistance to Gentamicin(high concentration), Streptomycin(high concentration), Penicillin, Erythromycin, Ampicillin, Ciprofloxacin, Levofloxacin, Rifampicin, and the drug resistance rates were higher than 50.00%. Enterococcus avian showed strong resistance to Clindamycin, Penicilling, Erythromycin, Ciprofloxacin and Levofloxacin. Previous history of biliary tract surgery, gallstones, pancreatic cancer, previous ERCP operation and APACHE II score ≥4 were the independent risk factors for biliary Enterococci infection. Conclusion Patients with biliary Enterococci infection will have elevated levels of inflammatory factors. The pathogens are mainly Enterococcus faecium, Enterococcus faecalis and Enterococcus faecalis. Enterococcus faecium has higher drug resistance rate. We should adopt the treatment plan according to the independent risk factors.