胰十二指肠切除术后腹腔感染的病原微生物分布及影响因素研究

Study on the distribution of pathogenic microorganisms and influencing factors in patients with abdominal infection after pancreaticoduodenectomy

目的分析胰十二指肠切除术(PD)后患者腹腔感染的病原微生物分布及影响因素。方法回顾性分析2019年5月至2022年12月在福建医科大学孟超肝胆医院行PD的108例壶腹部肿瘤、胰腺肿瘤、十二指肠肿瘤、胆总管恶性肿瘤等累及胰腺疾病患者的临床资料,其中男性65例,女性43例,年龄(59.28±17.88)岁,年龄范围28~80岁。依据患者PD后30 d内是否发生腹腔感染分为两组:感染组(n=37)和非感染组(n=71)。收集患者一般资料、实验室检测指标、病原微生物种类及药敏试验结果。logistic回归分析PD后腹腔感染的影响因素。结果患者术后腹腔感染率为34.26%(37/108),共检出病原微生物105株,其中革兰阴性菌43株(40.95%),革兰阳性菌36株(34.29%),真菌26株(24.76%)。病原微生物排名前5位的依次为屎肠球菌、白色念珠菌、嗜麦芽窄食单胞菌、铜绿假单胞菌及溶血葡萄球菌。药敏结果显示:未发现对替加环素和万古霉素耐药的屎肠球菌;白色念珠菌对两性霉素B敏感率为100%,对氟康唑耐药率仅为4.8%;嗜麦芽窄食单胞菌对头孢哌酮舒巴坦和左氧氟沙星耐药率分别为11.1%和33.3%;铜绿假单胞菌对亚胺培南和美罗培南耐药率分别为71.4%和28.6%。多因素logistic回归分析结果显示,术后腹腔出血(OR=10.997,95%CI:1.995~13.840,P=0.004)和胰瘘(OR=16.832,95%CI:1.938~146.174,P=0.010)的累及胰腺疾病患者,PD后发生腹腔感染的风险高。结论PD后腹腔感染的病原微生物以非发酵革兰阴性菌、肠球菌、白色念珠菌为主。腹腔出血和胰瘘是PD后腹腔感染的独立危险因素。

ObjectiveTo analyze the distribution of pathogenic microorganisms of abdominal infection in patients after pancreaticoduodenectomy and the influencing factors of postoperative abdominal infection.MethodsThe clinical data of 108 patients with pancreatic diseases,including ampullary tumors,pancreatic tumors,duodenal tumors,and malignant tumors of the common bile duct,who underwent pancreaticoduodenectomy in Mengchao Hepatobiliary Hospital of Fujian Medical University from May 2019 to December 2022 were retrospectively analyzed.Among them,65 were males,43 were females,aged(59.28±17.88)years old.Patients who underwent pancreaticoduodenectomy were categorized into two distinct cohorts based on the occurrence of abdominal infection within a 30-day postoperative period:the infected group(n=37)and the non-infected group(n=71).General data,laboratory test indicators,pathogen types and drug susceptibility test results of patients were collected.Logistic regression was used to analyze the influencing factors of postoperative pancreaticoduodenal abdominal infection.ResultsThe postoperative abdominal infection rate was 34.26%(37/108),and a total of 105 pathogenic bacteria were detected,including 43 gram-negative bacteria(40.95%),36 gram-positive bacteria(34.29%)and 26 fungi(24.76%).The top five pathogens were Enterococcus faecium,Candida albicans,Stenotrophomonas maltophilia,Pseudomonas aeruginosa and Staphylococcus haemolyticus.The drug sensitivity results showed that no tigecycline and vancomycin-resistant Enterococcus faecium strains.The sensitivity rate of Candida albicans to amphotericin B was 100%,and the resistance rate to fluconazole was only 4.8%.The resistance rates of Stenotrophomonas maltophilia to cefoperazone-sulbactam and levofloxacin are 11.1%and 33.3%,respectively.The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem are 71.4%and 28.6%,respectively.Multivariate logistic regression analysis showed that postoperative intra-abdominal bleeding(OR=10.997,95%CI:1.995-13.840,P=0.004)and pancreatic fistula(OR=16.832,95%CI:1.938-146.174,P=0.010)were risk factors for the occurrence of abdominal infection after pancreatoduodenectomy.ConclusionNon-fermented gram-negative bacteria,enterococcus and Candida albicans were the main pathogenic microorganisms in abdominal infection after pancreatoduodenectomy,and postoperative abdominal hemorrhage and pancreatic fistula were independent risk factors.