摘要
目的:分析胆石症患者并发胆道感染(biliary tract infection,BTI)的危险因素与病原学特点,为胆石症患者防治BTI提供参考。方法:选取2017年8月—2020年7月抚州市临川区妇幼保健院收治的268例胆石症患者作为研究对象,根据是否发生BTI将患者分为BTI组(n=134)和非BTI组(n=134);采集患者的年龄、性别、体质量指数、基础疾病情况、手术时长、结石数量、抗菌药物预防使用情况和病原学检查结果等资料,分析胆石症患者并发BTI的危险因素与病原学特点。结果:134例并发BTI患者的胆汁标本中共检出179株病原菌,其中革兰阴性菌123株(占68.72%,主要为大肠埃希菌和肺炎克雷伯菌)、革兰阳性菌51株(占28.49%,主要为肠球菌属)和真菌5株(占2.79%);药敏结果显示,大肠埃希菌和肺炎克雷伯菌对阿米卡星、庆大霉素、美罗培南和亚胺培南的耐药率较低(<30.00%),对哌拉西林和环丙沙星的耐药率较高(>40.00%);肠球菌属对庆大霉素、左氧氟沙星、阿米卡星、利奈唑胺和万古霉素的耐药率较低(<15.00%),对红霉素的耐药率较高(>80.00%);回归分析结果显示,年龄、体质量指数、胆道手术史、结石数目和手术时长与胆石症患者并发BTI具有相关性(P<0.05),其中年龄>60岁、体质量指数>25、有胆道手术史、结石数目>2个、手术时长>70 min是胆石症患者并发BTI的独立危险因素(P<0.05)。结论:胆石症合并BTI患者的病原菌以大肠埃希菌、肺炎克雷伯菌等革兰阴性菌为主,临床在进行抗菌药物治疗时应尽量依据病原菌的耐药特点选择合适药物;同时,患者发生胆道感染与年龄、体质量指数、胆道手术史、结石数目和手术时长具有相关性,临床应加强相关患者的防护,降低感染风险。
Objective:To investigate the risk factors and etiological characteristics of complicated biliary tract infection(BTI)in patients with cholelithiasis,so as to provide reference for the prevention and treatment of BTI in patients with cholelithiasis.Methods:A total of 268 patients with cholelithiasis,admitted to the Maternal and Child Health Hospital of Linchuan District,Fuzhou City from August 2017 to July 2020 were selected as study subjects,and they were divided into BTI group(n=134)and non-BTI group(n=134)according to whether BTI occurred.The data of patients such as age,gender,body mass index,underlying disease conditions,duration of surgery,stone count,prophylactic use of antibacterials and etiological examination results were collected to analyze the risk factors and etiological characteristics of complicated BTI in patients with cholelithiasis.Results:A total of 179 strains of pathogenic bacteria were detected in the bile specimens of 134 patients with BTI,including 123 strains of Gram-negative bacteria(68.72%,mainly Escherichia coli and Klebsiella pneumoniae),51 strains of Gram-positive bacteria(28.49%,mainly Enterococcus)and 5 strains of fungi(2.79%);the drug susceptibility test showed that the resistance rates of Escherichia coli and Klebsiella pneumoniae to amikacin,gentamicin,meropenem and imipenem were low(less than 30.00%),and their resistance rates to piperacillin and ciprofloxacin were high(greater than 40.00%);the resistance rate of Enterococcus to gentamicin,levofloxacin,amikacin,linezolid and vancomycin was low(less than 15.00%),and its resistance rate to erythromycin was high(greater than 80.00%).The regression analysis results showed that age,body mass index,history of biliary tract surgery,stone count and duration of surgery were associated with the complicated BTI in patients with cholelithiasis(P<0.05),of which,the age greater than 60 years old,body mass index greater than 25,history of biliary tract surgery,stone count greater than 2 and duration of surgery longer than 70 min were independ
作者
周华荣
施德泉
ZHOU Hua-rong;SHI De-quan(Maternal and Child Health Hospital of Linchuan District,Fuzhou City,Fuzhou Jiangxi 344001,China;The Affiliated Hospital of Jiangxi College of Traditional Chinese Medicine,Fuzhou Jiangxi 344000,China)
出处
《抗感染药学》
2022年第8期1189-1193,共5页
Anti-infection Pharmacy
关键词
胆石症
胆道感染
危险因素
病原菌分布
耐药情况
cholelithiasis
biliary tract infection
risk factor
distribution of pathogenic bacteria
drug resistance
