胆肠吻合术后胆道感染患者病原学及炎症标志物分析

Analysis of etiology and inflammatory markers in patients with biliary tract infection after choledocchojejunostomy

目的调查本院胆肠吻合术后胆道感染致病菌病原学特点及耐药情况,并借助有关炎症标志物,来评价其诊断术后胆道感染的诊断效能。方法选取河南省人民医院2020年9月—2022年8月行胆肠吻合术的351例患者为研究对象,分析其胆道感染病原菌的特征和药敏试验结果,并评估白细胞计数、中性粒细胞计数、C-反应蛋白、CAR和SII水平在术后胆道感染诊断中的价值。结果351例行胆肠吻合术后患者中有31例发生胆道感染(为感染组,其余为非感染组),感染率为8.83%,共分离出致病菌36株,其中革兰阴性菌25株(69.4%)、革兰阳性菌8株(22.22%)和真菌3株(8.33%),常见致病菌有大肠埃希菌、肺炎克雷伯菌、屎肠球菌等,在革兰氏阴性细菌中,以大肠埃希菌和肺炎克雷伯菌对氨苄西林的耐药性最强,而对碳青霉烯类抗生素的耐药性最弱;术前2组患者WBC、NEU、CAR、CRP及SII水平差异均无统计学意义,术后次日、术后3 d两组患者的WBC、NEU、CAR及CRP高于术前(均P<0.05),且感染组均高于非感染组(均P<0.05)。ROC曲线结果显示:联合指标的曲线下面积为0.887,各单个炎症指标均比联合指标预测价值低(均P<0.05)。结论本院行胆肠吻合术后出现的胆道感染主要由革兰阴性菌引起,例如肺炎克雷伯菌、大肠埃希菌等,且在常规抗生素治疗中具有较高的耐药性,可用于指导术后胆道感染经验性用药,对患者术后血清WBC、NEU、CAR及CRP水平进行检测可以预测术后发生胆道感染的可能。

Objective To investigate the pathogenic characteristics and drug resistance of pathogenic bacteria in biliary tract infection after cholangioenterostomy in Henan University People's Hospital and to evaluate the diagnostic value of biliary tract infection by relevant inflammatory markers.Methods A total of 351 patients who underwent choledocchojejunostomy from September 2020 to August 2022 in Henan Provincial People's Hospital were enrolled as the research objects.The characteristics of biliary tract infection pathogens and the results of drug sensitivity tests were analyzed.The levels of leukocytes,neutrophils,C-reactive protein(CRP),creactive protein-to-albumin ratio(CAR)and systemic immune-inflammation index(SII)were evaluated in diagnosing the occurrence of biliary tract infection.Results Among 351 patients,31 had biliary tract infections(infection group,the rest were uninfected group),and the infection rate was 8.83%.A total of 36 strains of pathogenic bacteria were isolated,including 25 strains of Gram-negative bacteria(69.4%)and 8 strains of Gram-positive bacteria(22.22%)and 3 strains of fungi(8.33%).The common pathogens were Escherichia coli,Klebsiella pneumoniae and Enterococcus faecium.Among the Gram-negative bacteria,Escherichia coli and Klebsiella pneumoniae had the highest drug-resistance rates to ampicillin and the lowest drug-resistance rates to carbapenem antibiotics.There was no statistically significant difference in WBC,NEU,CAR,CRP,and SII levels between the two groups of patients before surgery.The level of NEU,CAR,WBC and CRP between the two groups on the second and third day after operation were higher than those before operation(all P<0.05),and the infection group were higher than the uninfected group(all P<0.05).The results of ROC curve showed that the area under the curve of combined indexes was 0.887,and its predictive value were higher than those of each individual index(all P<0.05).Conclusion The main pathogenic bacteria of postoperative biliary tract infection in patients are Gram-negative bacteria such as Escherichia coli and Klebsiella pneumoniae,and they have strong drug-resistance to commonly used antibacterial drugs which can be used to guide postoperative preventive medication for biliary tract infection.The detection of serum WBC,NEU,CAR and CRP levels in patients can predict the occurrence of biliary tract infection after surgery.