ERCP术后胆道感染危险因素及其预测模型构建

Risk factors for postoperative biliary tract infection in ERCP patients and establishment of prediction model

目的探讨内镜逆行胰胆管造影术(ERCP)术后并发胆道感染病原菌分布、危险因素,并构建预测模型。方法选取2020年10月-2022年10月于空军军医大学第一附属医院行ERCP术患者1040例为研究对象,根据患者术后是否并发胆道感染分为并发胆道感染组30例和未并发胆道感染组1010例,收集患者临床资料,分析胆道感染病原菌分布及其危险因素,并构建预测模型,绘制受试者工作特征(ROC)曲线分析模型的预测价值。结果1040例ERCP术后患者并发胆道感染30例,发生率为2.88%,共培养病原菌42株,以大肠埃希菌为主,其次为粪肠球菌;胆道梗阻位置、ERCP术后未预防性使用抗菌药物、合并糖尿病是ERCP术后并发胆道感染的独立危险因素(P<0.05),构建的预测模型为:Logit(P)=-11.087+胆道梗阻位置高位×0.927+ERCP术后未预防性使用抗菌药物×0.958+合并糖尿病×1.042,按照诊断概率Logit(P)绘制预测ERCP术后患者并发胆道感染的ROC曲线,当Logit(P)>11时,AUC值为0.843,敏感度为86.67%,特异度为67.43%。结论ERCP术后并发胆道感染病原菌以革兰阴性菌为主,危险因素包括胆道梗阻位置高位、ERCP术后未预防性使用抗菌药物、合并糖尿病,据此构建预测模型的预测价值较高。

OBJECTIVE To explore the distribution of pathogens and risk factors for postoperative biliary tract in-fection in the patients undergoing endoscopic retrograde cholangiopancreatography(ERCP)and establish the pre-diction model.METHODS Totally 1040 patients who underwent ERCP in the First Affiliated Hospital of Air Force Military Medical University from Oct 2020 to Oct 2022 were recruited as the research subjects and were di-vided into the biliary tract infection group with 30 cases and the no biliary tract infection group with 1010 cases according to the status of postoperative biliary tract infection.The clinical data were collected from the patients,the distribution of pathogens and risk factors for the biliary tract infection were analyzed,the prediction model was established,and the predictive value of the model was analyzed by receiver operating characteristic(ROC)curves.RESULTS Among the 1010 patients who underwent ERCP,30 had postoperative biliary tract infection,with the incidence rate 2.88%.Totally 42 strains of pathogens were isolated,among which Escherichia coli was domi-nant,followed by Enterococcus faecalis.Location of biliary tract obstruction,no prophylactic use of antibiotics af-ter ERCP and complication with diabetes mellitus were the independent risk factors for the postoperative biliary tract infection(P<0.05).The prediction model was as follows:Logit(P)=-11.087+high location of biliary tract obstruction×0.927+no prophylactic use of antibiotics after ERCP×0.958+complication with diabetes mellitus×1.042,the ROC curves for the prediction of postoperative biliary tract infection were drawn according to the diagnostic probability Logit(P),when the Logit(P)was greater than 11,the AUC was 0.843,with the sensi-tivity 86.67%,the specificity 67.43%.CONCLUSION The gram-negative bacteria are dominant among the patho-gens isolated from the ERCP patients with postoperative biliary tract infection.The risk factors include the high location of biliary tract obstruction,no prophylactic use of antibiotics after ERCP and complication with diabetes mellitus.The prediction model has high predictive value.