抗菌药物使用对Kasai术后胆管炎多重耐药菌定植的影响分析

Analysis of the effect of antibiotic use on the colonization of multi drug resistant bacteria in patients with cholangitis after Kasai operation

目的分析Kasai术后患儿肠道定植菌的耐药情况及抗菌药物使用对多重耐药菌(multidrug resistant organisms,MDROs)定植的影响,以期为Kasai术后胆管炎患儿MDROs定植的预防和治疗提供参考依据。方法收集2021年1月至2022年6月天津市第一中心医院收治的Kasai术后胆管炎病例,根据患儿入院时的MDROs定植情况将患儿分为病例组(定植)和对照组(无定植),比较两组患儿的一般情况、Kasai术时日龄、胆道闭锁分型、既往胆管炎次数与既往静脉抗菌药物使用情况。结果共纳入64例患儿,MDROs组43例,非MDROs组21例。从直肠拭子中检出致病菌76株,肺炎克雷伯杆菌最多(37例,耐碳青霉烯类33例),其次为屎肠球菌(12例,耐万古霉素1例)、大肠埃希菌(11例,耐碳青霉烯类4例)。两组患儿一般情况、Kasai术时日龄、胆道闭锁分型、既往胆管炎次数无统计学差异;MDROs组碳青霉烯类抗菌药物使用率高于非MDROs组,分别为53.5%和33.3%(P=0.129),MDROs组广谱抗菌药物使用率高于非MDROs组,分别为39.5%和19.0%(P=0.101),MDROs组2种以上抗菌药物联合静脉应用率高于非MDROs组,分别为51.2%和19.0%(P=0.014)。结论两种以上抗菌药物联合应用可能会导致MDROs的定植,从而因肠道细菌移位引起MDROs的血流感染和胆道感染。因此应采取有效防治措施,合理应用抗菌药物,减少Kasai术后患儿MDROs的发生。

Objective To investigate the colonization of multidrug resistant organisms(MDROs)and the impact of antibiotic therapies on MDROs colonization in patients with cholangitis after Kasai procedure,and to provide scientific evidence for clinical prevention and control measures.Methods Cases with cholangitis after Kasai surgery from January 2021 to June 2022 in Tianjin First Central Hospital were retrospectively collected.The children were divided into case group(colonized)and control group(non-colonized)according to their MDROs colonization status when admitted to pediatric department,and the general conditions,Kasai procedure time,biliary atresia classification,previous cholangitis times and previous use of antibiotics were compared between the two groups.Results A total number of 76 strains of pathogenic bacteria were detected in rectal swabs of 64 children,including 43 in the MDROs group and 21 in the non-MDROS group.Klebsiella pneumoniae was the most common bacterium(37 cases,33 cases were carbapenem-resistant),followed by Enterococcus faecium(12 cases,1 case was vancomycin resistant)and Escherichia coli(11 cases,4 cases were carbapenem-resistant).There were no significant differences in general conditions,Kasai operation time,biliary atresia classification,and previous cholangitis times between the two groups.The rate of therapy with carbapenems in MDROs group was higher than that in non-MDROS group(53.5%vs.33.3%,P=0.129).The rate of therapy with broad-spectrum antibiotics in MDROs group was higher than that in non-MDROS group(39.5%vs.19.0%,P=0.101).The rate of therapy with more than two antibiotics in MDROs group was higher than that in non-MDROS group(51.2%vs.19.0%,P=0.014).Conclusion Combination antimicrobial therapy with two or more drugs may lead to colonization of MDROs,resulting in bloodstream infection and biliary tract infection of MDROs due to intestinal bacterial translocation.Therefore,effective prevention and treatment measures should be taken to reduce the incidence of MDROs in children after Kasai.