不同胆道系统疾病的胆汁细菌谱与耐药性分析

Analysis of bile bacterial spectrum and drug resistance in different biliary diseases

目的通过不同胆道系统疾病的胆汁细菌培养结果明确其细菌谱及耐药情况。方法回顾性收集2015年1月—2016年12月解放军总医院行手术治疗并留取胆汁细菌培养的患者,记录其胆汁细菌培养及抗菌药物敏感试验结果、手术原因、围手术期并发症等临床资料。结果共纳入272例患者,男性142例,女性130例,年龄为(53.4±14.1)岁。其中肝内外胆管结石为最主要的手术病因,占32.4%。良性疾病胆汁细菌培养的阳性率为78.7%,高于恶性疾病胆汁细菌培养的阳性率(48.5%)。胆汁细菌培养阳性组的感染相关性并发症(30.0%vs.6.7%)、胆漏率(20.8%vs.6.7%)以及切口愈合不良率(24.0%vs.0.0%)高于胆汁细菌培养阴性组(P<0.05)。183例胆汁细菌培养阳性患者中,共检出致病菌294株。单种细菌感染患者96例,2种细菌同时感染的患者66例,合并3种细菌感染的患者18例,4种及以上细菌感染的患者3例。其中大肠埃希菌为最常见细菌,占17.0%。不同病因患者的胆汁细菌培养阳性率存在差异(P<0.05)。粪肠球菌和屎肠球菌对于很多抗菌药物的敏感率存在显著差异。结论不同病因患者胆道内细菌培养阳性率存在差异,并且存在混合感染可能,需要根据不同病因选择适合的抗菌药物进行经验性治疗,并根据胆汁细菌培养结果及时更改抗菌药物。

Objective To clarify the bacterial spectrum and drug resistance of different biliary diseases through bile culture results.Methods Patients who underwent surgical treatment and retained bile for cultivation at the Chinese PLA General Hospital between January 2015 and December 2016 were retrospectively collected.Clinical data such as bile bacterial culture and antibiotic sensitivity results,surgical reasons,and perioperative complications were recorded.Results A total of 272 patients were included,including 142 males and 130 females,aged(53.4±14.1)years old.Intrahepatic and extrahepatic bile duct stones were the most common surgical cause,accounting for 32.4%.The positive rate of bile culture in benign diseases was 78.7%,which was higher than that in malignant diseases(48.5%).The infection related complications(30.0%vs.6.7%),bile leakage rate(20.8%vs.6.7%),and poor wound healing rate(24.0%vs.0.0%)in the bile culture positive group were higher than those in the bile bacteria culture negative group(P<0.05).Among 183 patients with positive bile bacterial culture,a total of 294 strains of pathogenic bacteria were detected.There were 96 patients with single bacterial infection,66 patients with two bacterial infections simultaneously,18 patients with three bacterial infections,and 3 patients with four or more bacterial infections.Escherichia coli was the most common bacterium,accounting for 17.0%.There were differences in the positive rate of bile culture among patients with different etiologies(P<0.05).There were significant differences in the sensitivity rate of Enterococcus faecalis and Enterococcus faecalis for many antibacterial drugs.Conclusions There are differences in the positive rate of bacterial culture in the biliary tract of patients with different etiologies,and there is a possibility of mixed infection.It is necessary to select appropriate antibiotics for empirical treatment based on different etiologies.The use of antibiotics should be changed in a timely manner based on the results of bile culture.