胆结石患者术后感染病原菌耐药特征及影响因素

Drug Resistance Characteristics and Influencing Factors of Postoperative Infection Pathogens in Patients With Gallstones

目的:分析胆结石患者术后感染病原菌耐药特征及影响因素。方法:选取2019年9月—2023年5月本院胆结石患者术后感染患者76例,并以1∶1配比选取同期术后未发生感染的76例患者作为对照组,采集胆汁标本,进行病原菌培养及药敏试验,分析病原菌分布及耐药性;并收集患者性别、年龄、病程、基础疾病、切除方式、腹腔血糖、术前降钙素原、手术时间、胆囊破裂、结石数量、既往胆结石史等临床资料,分析影响胆结石患者术后发生感染的相关因素。结果:术后感染患者76例,胆汁共分离出革兰阴性菌65株(73.03%),以大肠埃希菌(28.09%)、肺炎克雷伯菌(23.60%)为主;革兰阳性菌24株(26.97%),以粪肠球菌(12.36%)、屎肠球菌(10.11%)为主。大肠埃希菌对阿莫西林、头孢唑啉、头孢呋辛、头孢噻肟耐药率较高,分别为72.00%、96.00%、68.00%、60.00%,对哌拉西林他唑巴坦、阿米卡星、头孢替坦、厄他培南耐药率较低,均为0.00%。肺炎克雷伯菌对阿莫西林、头孢唑啉、头孢呋辛耐药率较高,分别为100.00%、85.71%、61.90%,对头孢替坦、厄他培南耐药率较低,分别为4.76%、0.00%。粪肠球菌对青霉素G、克林霉素耐药率高,分别为90.91%、72.73%,对利奈唑烷、替加环素、万古霉素耐药率低,均为0.00%;屎肠球菌对青霉素G、克林霉素、红霉素耐药率高,均为77.77%,对利奈唑烷、替加环素、万古霉素耐药率低,均为0.00%。单因素分析显示,两组病程、基础疾病、切除方式、腹腔血糖、术前降钙素原比较,差异无统计学意义(P>0.05);而两组手术时间、胆囊破裂、结石数量、既往胆结石史比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,手术时间≥90 min、胆囊破裂、结石数量≥3个、既往胆结石史是胆结石患者术后发生感染的危险因素(P<0.05)。结论:胆结石术后发生感染患者,主要致病菌为大肠埃希菌,致病菌对常用抗生素存在一定耐药性,需根据药敏实验科学选择抗菌药物,提高抗菌效果,且临床需结合相关危险因素采取相应措施,减少术后感染。

Objective:To analyze the drug resistance characteristics and influencing factors of pathogenic bacteria in postoperative infection of patients with gallstones.Methods:A total of 76 patients with postoperative infection of gallstones in our hospital from September 2019 to May 2023 were selected,and 76 patients without postoperative infection during the same period were selected as the control group at a ratio of 1∶1.Bile samples were collected for pathogen culture and drug sensitivity test,and the distribution and drug resistance of pathogens were analyzed.The clinical data of patients'gender,age,course of disease,basic diseases,resection methods,intraperitoneal blood glucose,preoperative procalcitonin,operation time,gallbladder rupture,settlement number,previous history of gallstones and other clinical data were collected,and the related factors affecting postoperative infection in patients with gallstones were analyzed.Results:Among 76 patients with postoperative infection,65 strains of Gram-negative bacteria(73.03%)were isolated from bile,mainly Escherichia coli(28.09%)and Klebsiella pneumoniae(23.60%).There were 24 strains of Grampositive bacteria(26.97%),mainly Enterococcus faecalis(12.36%)and Enterococcus faecium(10.11%).The resistance rates of Escherichia coli to amoxicillin,cefazolin,cefuroxime and cefotaxime were 72.00%,96.00%,68.00%and 60.00%,respectively.The resistance rates to piperacillin tazobactam,amikacin,cefotetan and ertapenem were 0.00%.The resistance rates of Klebsiella pneumoniae to amoxicillin,cefazolin and cefuroxime were 100.00%,85.71%and 61.90%,respectively.The resistance rates to cefotetan and ertapenem were 4.76%and 0.00%,respectively.The resistance rates of Enterococcus faecalis to penicillin G and clindamycin were 90.91%and 72.73%,respectively,and the resistance rates to linezolid,tigecycline and vancomycin were 0.00%.The resistance rates of Enterococcus faecium to penicillin G,clindamycin and erythromycin were 77.77%,and the resistance rates to linezolid,tigecycline and vancomycin were 0.00%.Univariate analysis showed that there was no significant difference in the course of disease,basic disease,resection method,abdominal blood glucose and preoperative procalcitonin between the two groups(P>0.05),while there were significant differences between the two groups in operation time,gallbladder rupture,settlement number and previous history of gallstones(P<0.05).Multivariate Logistic regression analysis showed that operation time≥90 min,gallbladder rupture,settlement number≥3,and previous history of gallstones were risk factors for postoperative infection in patients with gallstones(P<0.05).Conclusion:Escherichia coli is the main pathogenic bacteria in patients with infection after gallstone surgery.Pathogenic bacteria have certain resistance to commonly used antibiotics.It is necessary to select antibiotics scientifically according to drug sensitivity experiments to improve the antibacterial effect,and corresponding measures should be taken in combination with relevant risk factors to reduce postoperative infection.