摘要
目的探讨先天性胆道闭锁肝门空肠吻合术后胆管炎的抗生素选择治疗方案。方法收集我院2007-2016年先天性胆道闭锁术后胆管炎患儿共300例,回顾性分析临床类型、常见致病菌及抗生素敏感情况。结果 (1)300例患儿共发作胆管炎541次,其中血培养阳性128次。(2)引起胆道闭锁术后胆管炎的主要致病菌为大肠埃希菌、铜绿假单胞菌和肠球菌。晚期胆管炎和频发胆管炎需警惕肠球菌感染。(3)药敏分析:大肠杆菌、铜绿假单胞菌对头孢哌酮舒巴坦的敏感率分别为75%、78%,对哌拉西林他唑巴坦的敏感率分别为82%、84%,对美罗培南的敏感率分别为93%、76%;肠球菌对万古霉素/利奈唑胺的敏感率为100%。结论头孢哌酮舒巴坦和哌拉西林他唑巴坦可做为胆道闭锁术后胆管炎的首选抗生素,治疗效果欠佳时应及时更换美罗培南。晚期胆管炎和频发胆管炎需警惕肠球菌感染。
Objective To explore the pathogenic bacterial distribution and drug sensitivity of eholangiitis in children who underwent hepatieo-portoenterostomy for congenital biliary atresia in order to provide the guide for appropriate treatment. Methods The clinical data of 300 eases of congenital biliary atresia Kasai postoperative eholangitis in our hospital between 2007 and 2016 were included in the study to analyse the common pathogenic bacteria and antibiotics sensitivity according to its clinical types. Results （ 1 ） In the 300 children, eholangitis set on for 541 times, with blood culture positive in 128 cases. （2）The main pathogens of eholangitis after biliary atresia included escherichia coli, pseudomonas aeruginosa and enterocoecus. Late eholangitis and frequent cholangitis contributed highly to enteroeoecus infections. （3）The sensitivity rates of eseherichia coli and pseudomonas aeruginosa to cefoperazone sulbactam were 75% and 78%, respectively, and the rates to piperacillin tazobactam were 82% and 84%, respectively. The sensitivity rates to meropenem were 93% and 76%, respectively. The susceptibility of Enteroeoceus to vancomycin or linezolid was 100%. Conclusions Cefoperazone sulbactam and piperacillin tazobaetam can be used as an option of antibiotics for biliary atresia Kasai postoperative cholangitis. In case of poor curative effect, timely replacement of meropenem is suggested. In case of late cholangitis and frequent cholangitis, enterococcus infection can be considered in its diagnosis.
出处
《实用医学杂志》
CAS
北大核心
2018年第3期435-438,共4页
The Journal of Practical Medicine
关键词
胆道闭锁
胆管炎
抗生素
biliary atresia
cholangitis
antibiotics
