慢性结石性胆囊炎多重耐药菌感染的影响因素分析

Influencing factors for infection with multidrug-resistant organisms in patients with chronic calculous cholecystitis

目的分析慢性结石性胆囊炎患者合并多重耐药菌(MDRO)感染的影响因素。方法回顾性调查分析2014年2月-2019年12月于贵州医科大学第三附属医院行胆囊切除术慢性结石性胆囊炎654例,分为MDRO感染(n=178)与非MDRO感染(n=476)。收集患者年龄、性别、病程、BMI、有无糖尿病、结石大小、发作频率、结石有无嵌顿、结石数量、胆囊有无萎缩、有无合并胆管结石、有无合并胆囊息肉、有无合并胰腺炎、ALT、抗菌药物使用持续时间、抗菌药物使用频率、联用抗菌药物、是否采用利胆治疗、入院时血糖、糖化血红蛋白、AST、是否进行中医药治疗、是否发生MDRO感染及其菌种等临床资料。符合正态分布的计量资料两组间比较采用t检验;不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ~2检验。采用多因素logistic回归分析进行影响因素分析。结果慢性结石性胆囊炎MDRO感染率为27.22%。两组在病程(Z=3.503,P <0.001)、BMI(t=2.153,P=0.032)、糖尿病(χ~2=4.866,P=0.027)、结石大小(t=3.276,P=0.001)、发作频率(Z=2.574,P=0.010)、嵌顿(χ~2=14.880,P <0.001)、结石数量(Z=4.268,P <0.001)、胆囊萎缩(χ~2=14.855,P <0.001)、合并胆囊息肉(χ~2=14.234,P <0.001)、入院糖化血红蛋白(t=2.233,P=0.026)、抗菌药物使用频率(t=2.302,P=0.022)、联用抗菌药物(Z=3.314,P=0.001)、入院血糖(t=3.420,P=0.001)、抗菌药物使用持续时间(t=2.024,P=0.044)、中医药治疗(χ~2=7.529,P=0.006)、利胆治疗(χ~2=9.826,P=0.002)等方面比较差异均有统计学意义。嵌顿(OR=2.476,95%CI:1.544~3.972)、胆囊萎缩(OR=3.548,95%CI:2.198~5.725)、合并胆囊息肉(OR=3.198,95%CI:1.928~5.305)、抗菌药物使用频率(OR=1.936,95%CI:1.257~2.981)、联用抗菌药物(OR=3.429,95%CI:2.049~5.736)是慢性结石性胆囊炎MDRO感染的独立危险因素(P值均<0.05),而中医药治疗(OR=0.640,95%CI:0.433~0.945)与利胆治疗(OR=0.548,95%CI:0.354~0.847)是慢性结石性胆囊炎MDRO感染的独立保护因素(P值均<0.05)。结论合理使用抗菌药物,辅助利胆与中医药治疗,减少不必联合与反复使用抗菌药物,具有结石嵌顿等手术指征时及早手术治疗,避免长期反复感染引起胆囊萎缩与胆囊息肉等形成,可降低慢性结石性胆囊炎MDRO感染风险。

Objective To investigate the influencing factors for multidrug-resistant organisms(MDRO)infection in patients with chronic calculous cholecystitis.Methods A retrospective analysis was performed for 654 patients with chronic calculous cholecystitis who underwent cholecystectomy in The Third Affiliated Hospital of Guizhou Medical University from February 2014 to December 2019,and the patients were divided into MDRO infection group with 178 patients and non-MDRO infection group with 476 patients.Related clinical data and medical history were recorded,including age,sex,course of disease,body mass index(BMI),presence or absence of diabetes mellitus/stone incarceration/gallbladder atrophy/bile duct stones/gallbladder polyps/pancreatitis,stone size,attack frequency,number of stones,alanine aminotransferase,duration of antibiotic use,frequency of antibiotic use,combined use of antibiotics,application of cholagogic treatment,blood glucose on admission,glycosylated hemoglobin on admission,aspartate aminotransferase,application of traditional Chinese medicine treatment,and presence or absence of MDRO infection and related strains.The t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups;a multivariate logistic regression analysis was used to perform a multivariate analysis.Results The MDRO infection rate was 27.22%in patients with chronic calculous cholecystitis.There were significant differences between the two groups in course of disease(Z=3.503,P<0.001),BMI(t=2.153,P=0.032),diabetes mellitus(χ2=4.866,P=0.027),stone size(t=3.276,P=0.001),attack frequency(Z=2.574,P=0.010),stone incarceration(χ2=14.880,P<0.001),number of stones(Z=4.268,P<0.001),gallbladder atrophy(χ2=14.855,P<0.001),gallbladder polyps(χ2=14.234,P<0.001),glycosylated hemoglobin on admission(t=2.233,P=0.026),frequency of antibiotic use(t=2.302,P=0.022),combined use of antibiotics(Z=3.314,P=0.001),blood glucose on admission(t=3.420,P=0.001),duration of antibiotic use(t=2.024,P=0.044),traditional Chinese medicine treatment(χ2=7.529,P=0.006),and cholagogic treatment(χ2=9.826,P=0.002).Incarceration(odds ratio[OR]=2.476,95%confidence interval[CI]:1.544-3.972,P<0.05),gallbladder atrophy(OR=3.548,95%CI:2.198-5.725,P<0.05),gallbladder polyps(OR=3.198,95%CI:1.928-5.305,P<0.05),frequency of antibiotic use(OR=1.936,95%CI:1.257-2.981,P<0.05),and combined use of antibiotics(OR=3.429,95%CI:2.049-5.736,P<0.05)were independent risk factors for MDRO infection in patients with chronic calculous cholecystitis,while traditional Chinese medicine treatment(OR=0.640,95%CI:0.433-0.945,P<0.05)and cholagogic treatment(OR=0.548,95%CI:0.354-0.847,P<0.05)were independent protective factors against MDRO infection in patients with chronic calculous cholecystitis.Conclusion The risk of MDRO infection in patients with chronic calculous cholecystitis can be reduced by rational use of antibiotics,auxiliary cholagogic and traditional Chinese medicine treatment,reduction in combined and repeated use of antibiotics,early surgical treatment in case of indications such as stone incarceration,and avoidance of gallbladder atrophy and polyps caused by long-term recurrent infection.