急性胰腺炎患者胆道感染的病原体特征及危险因素分析

Characteristics and risk factors analysis of biliary pathogens infection in patients with acute pancreatitis

目的探讨急性胰腺炎(AP)患者胆道感染的病原体特征及危险因素。方法选取2019年7月—2021年2月于河南省某医院就诊的360例AP患者,采集胆道感染患者胆汁样本进行细菌培养、菌株鉴定、药敏分析,采用多因素Logistic回归分析AP患者发生胆道感染的危险因素。结果360例AP患者胆道感染发生率为20.83%(75/360),共分离出病原菌90株,其中革兰氏阴性菌、革兰氏阳性菌、真菌分别占比64.44%、30.00%、5.56%。主要革兰氏阴性菌中,大肠埃希菌对哌拉西林、环丙沙星、头孢唑啉耐药率较高,分别为85.00%、70.00%、55.00%;肺炎克雷伯菌对哌拉西林、头孢他啶、环丙沙星耐药率较高,分别为86.67%、73.33%、60.00%。主要革兰氏阳性菌中,金黄色葡萄球菌对青霉素、红霉素、氨苄西林耐药率较高,分别为80.00%、60.00%、50.00%;表皮葡萄球菌对青霉素、氨苄西林、红霉素耐药率较高,分别为85.71%、71.43%、57.14%。多因素Logistic回归分析结果显示,老年、侵入性操作、合并胆道疾病、急性生理学及慢性健康状况评分系统(APACHEⅡ)评分>11分是AP患者发生胆道感染的危险因素(P<0.05)。结论AP患者伴胆道感染的病原体具有一定特点,感染病原菌以革兰氏阴性菌为主,可优先选择替考拉宁、万古霉素等相对敏感的药物治疗;临床应重点关注老年及合并胆道疾病等AP患者的病情发展,以预防胆道感染发生。

Objective To investigate the characteristics and risk factors of biliary pathogens infection in patients with acute pancreatitis(AP).Methods A total of 360 patients with AP attending a hospital in Henan Province from July 2019 to February 2021 were selected.Bile samples from patients with biliary tract infection were collected for bacterial culture,strain identification,and drug sensitivity analysis.The multi-factor logistic regression was adopted to analyze the risk factors in the occurrence of biliary tract infection in patients with AP.Results The incidence of biliary tract infection in 360 cases of AP was 20.83%(75/360),and a total of 90 pathogenic bacteria were isolated,of which Gram-negative,Gram-positive and fungal bacteria accounted for 64.44%,30.00%and 5.56%,respectively.Among the major Gram-negative bacteria,Escherichia coli had higher resistance rates to piperacillin,ciprofloxacin and cefazolin,with a drug resistance rate of 85.00%,70.00%and 55.00%,respectively;Klebsiella pneumoniae had higher resistance rates to piperacillin,ceftazidime and ciprofloxacin,with a drug resistance rate of 86.67%,73.33%and 60.00%,respectively.Among the major Gram-positive bacteria,Staphylococcus aureus had higher resistance rates to penicillin,erythromycin,and ampicillin,with a drug resistance rate of 80.00%,60.00%,and 50.00%,respectively;and Staphylococcus epidermidis had higher resistance rates to penicillin,ampicillin,and erythromycin,with a drug resistance rate of 85.71%,71.43%,and 57.14%,respectively.The results of multi-factor logistic regression analysis showed that old age,invasive operation,combined biliary tract disease,and APACHEⅡscore over 11 were the risk factors in the development of biliary tract infection in patients with AP(P<0.05).Conclusion Patients with AP combined with biliary tract infection indicate certain pathogenic characteristics,and the infecting pathogens are mainly Gram-negative bacteria,and relatively sensitive drugs such as teicoplanin and vancomycin can be preferred for treatment.Special attention should be paid on the development of AP patients clinically,such as old age and combined biliary tract diseases to prevent the occurrence of biliary tract infection.