| 摘要: |
| 目的 分析天津市南开医院临床常见的胆道感染病原学特征及危险因素，为胆道感染的临床治疗用药提供依据。方法:选取2020年1月—2022年12月天津市南开医院收治的672例胆道疾病患者作为研究对象，根据是否发生胆道感染(BTI)将患者分为BTI组(n=361)和非BTI组(n=311)；采集患者的年龄、性别、基础疾病情况、胆结石数量、抗菌药物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征。结果:胆汁培养共分离病原菌3 534株，其中革兰阴性菌2 375株，占67.20%；革兰阳性菌1 058株，占29.94%；真菌92株，占2.60%。大肠埃希菌对环丙沙星的耐药率呈上升趋势(P<0.05)，对阿米卡星的耐药率有所下降(P<0.05)；肺炎克雷伯菌对多种头孢菌素类、碳青霉烯类、-内酰胺酶抑制剂类、头酶类、氨基糖苷类和喹诺酮类抗生素耐药性均升高(P<0.05)。屎肠球菌对四环素的耐药率逐年上升(P<0.05)，粪肠球菌对红霉素和高浓度庆大霉素的耐药率下降(P<0.05)。年龄、胆道手术史、结石数目与胆道疾病患者并发BTI具有相关性(P＜0.05)，其中年龄＞65岁、有胆道手术史、结石数目＞2个是胆石症患者并发BTI的独立危险因素(P＜0.05)。结论:临床胆道感染分离的病原菌以革兰阴性杆菌最常见，耐药性不断变迁，应根据药敏结果合理用药；患者发生胆道感染与年龄、胆道手术史和胆结石数目有相关性，临床应增强感染防护。 |
| 关键词: 胆道感染 病原菌 耐药性 |
| DOI：10.3969/j.issn.1007-6948.2024.02.020 |
| 投稿时间：2023-05-01 |
| 基金项目:南开金域横向课题项目(NKYY-IIT-2022-009-3) |
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| Etiological characteristics and risk factors of common clinical biliary tract infections from 2020 to 2022 |
| CHEN Ming-hui，ZHANG Ai-min，XUE Hai-ling |
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| Abstract: |
| Objective The etiological characteristics and risk factors of biliary tract infection were analyzed to provide the basis for clinical treatment of biliary tract infection. Methods 672 patients with biliary tract infection treated in Tianjin Nankai Hospital from 2020 to 2022 were selected as research objects. According to whether or not they had BTI, the patients were divided into two groups: BTI infection group (n=361) and non-BTI group (n=311). The risk factors and etiological characteristics of BTI in patients with cholelithiasis were analyzed by collecting the data of age, sex, basic diseases, number of gallstones, use of antibiotics and etiological examination results. Results A total of 3534 pathogens were isolated from bile culture, among which 2375 were gram-negative, accounting for 67.20%. 1058 strains of gram-positive bacteria, accounting for 29.94%; 92 strains of fungi, accounting for 2.60%. The resistance rate of Escherichia coli to ciprofloxacin was increased (P<0.05), and the resistance rate to amikacin was decreased (P<0.05). The resistance of Klebsiella pneumoniae to several cephalosporins, carbapenems, lactamase inhibitors, cephalases, aminoglycosides and quinolones was increased (P<0.05). The resistance rate of enterococcus faecium to tetracycline increased year by year (P<0.05), while the resistance rate of enterococcus faecalis to erythromycin and high concentration gentamicin decreased (P<0.05). Regression analysis showed that age, history of biliary tract surgery and number of stones were correlated with BTI in patients with Biliary tract disease (P < 0.05), among which age > 65 years old, history of Biliary tract surgery and number of stones > 2 were independent risk factors for BTI in patients with cholelithiasis (P < 0.05). Conclusion Gram-negative bacilli are the most common pathogens isolated from biliary tract infection, and drug resistance is constantly changing, so rational drug use should be based on drug sensitivity results. The occurrence of biliary tract infection is related to the age, the history of biliary tract operation and the number of gallstones. |
| Key words: Biliary tract infection pathogenic bacteria antimicrobial resistance |
