慢性结石性胆囊炎多重耐药菌感染的影响因素分析

谢朝云; 张萍; 杨怀; 莫立显; 王民开

doi:10.3969/j.issn.1001-5256.2020.11.018

慢性结石性胆囊炎多重耐药菌感染的影响因素分析

DOI: 10.3969/j.issn.1001-5256.2020.11.018

1. 贵州医科大学第三附属医院感染管理科
2. 黔南州人民医院住院处
3. 贵州省人民医院感染管理科
4. 贵州医科大学第三附属医院普外科

基金项目:

贵州省科技厅联合项目（黔科合LH字[2014]7162号）；贵州省黔南州社会发展科技项目（黔南科合社字[2018]7号）；

详细信息

中图分类号: R575.61
计量
- 文章访问数: 4243
- HTML全文浏览量: 39
- PDF下载量: 91
- 被引次数: 0
出版历程
- 收稿日期: 2020-05-23
- 出版日期: 2020-11-20

Influencing factors for infection with multidrug-resistant organisms in patients with chronic calculous cholecystitis

Department of Infection Management,The Third Affiliated Hospital of Guizhou Medical University
Department of Admission,The People's Hospital of Qiannan Prefecture
Department of Infection Management,Guizhou Provincial People's Hospital
Department of General Surgery,The Third Affiliated Hospital of Guizhou Medical University

Research funding:

摘要

摘要:
目的分析慢性结石性胆囊炎患者合并多重耐药菌（MDRO）感染的影响因素。方法回顾性调查分析2014年2月-2019年12月于贵州医科大学第三附属医院行胆囊切除术慢性结石性胆囊炎654例,分为MDRO感染（n=178）与非MDRO感染（n=476）。收集患者年龄、性别、病程、BMI、有无糖尿病、结石大小、发作频率、结石有无嵌顿、结石数量、胆囊有无萎缩、有无合并胆管结石、有无合并胆囊息肉、有无合并胰腺炎、ALT、抗菌药物使用持续时间、抗菌药物使用频率、联用抗菌药物、是否采用利胆治疗、入院时血糖、糖化血红蛋白、AST、是否进行中医药治疗、是否发生MDRO感染及其菌种等临床资料。符合正态分布的计量资料两组间比较采用t检验;不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ2检验。采用多因素logistic回归分析进行影响因素分析。结果慢性结石性胆囊炎MDRO感染率为27.22%。两组在病程（Z=3.503,P<0.001）、BMI（t=2.153,P=0.032）、糖尿病（χ2=4.866,P=0....
- 胆囊炎 /
- 多重耐药菌 /
- 感染
Abstract:
Objective To investigate the influencing factors for multidrug-resistant organisms( MDRO) infection in patients with chronic calculous cholecystitis. Methods A retrospective analysis was performed for 654 patients with chronic calculous cholecystitis who underwent cholecystectomy in The Third Affiliated Hospital of Guizhou Medical University from February 2014 to December 2019,and the patients were divided into MDRO infection group with 178 patients and non-MDRO infection group with 476 patients. Related clinical data and medical history were recorded,including age,sex,course of disease,body mass index( BMI),presence or absence of diabetes mellitus/stone incarceration/gallbladder atrophy/bile duct stones/gallbladder polyps/pancreatitis,stone size,attack frequency,number of stones,alanine aminotransferase,duration of antibiotic use,frequency of antibiotic use,combined use of antibiotics,application of cholagogic treatment,blood glucose on admission,glycosylated hemoglobin on admission,aspartate aminotransferase,application of traditional Chinese medicine treatment,and presence or absence of MDRO infection and related strains. The t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups; a multivariate logistic regression analysis was used to perform a multivariate analysis. Results The MDRO infection rate was 27. 22% in patients with chronic calculous cholecystitis.There were significant differences between the two groups in course of disease( Z = 3. 503,P < 0. 001),BMI( t = 2. 153,P = 0. 032),diabetes mellitus( χ2= 4. 866,P = 0. 027),stone size( t = 3. 276,P = 0. 001),attack frequency( Z = 2. 574,P = 0. 010),stone incarceration( χ2= 14. 880,P < 0. 001),number of stones( Z = 4. 268,P < 0. 001),gallbladder atrophy( χ2= 14. 855,P < 0. 001),gallbladder polyps( χ2= 14. 234,P < 0. 001),glycosylated hemoglobin on admission( t = 2. 233,P = 0. 026),frequency of antibiotic use( t = 2. 302,P = 0. 022),combined use of antibiotics( Z = 3. 314,P = 0. 001),blood glucose on admission( t = 3. 420,P = 0. 001),duration of antibiotic use( t = 2. 024,P = 0. 044),traditional Chinese medicine treatment( χ2= 7. 529,P = 0. 006),and cholagogic treatment( χ2= 9. 826,P = 0. 002). Incarceration( odds ratio [OR]= 2. 476,95% confidence interval [CI]: 1. 544-3. 972,P < 0. 05),gallbladder atrophy( OR = 3. 548,95% CI: 2. 198-5. 725,P < 0. 05),gallbladder polyps( OR = 3. 198,95% CI: 1. 928-5. 305,P < 0. 05),frequency of antibiotic use( OR = 1. 936,95% CI: 1. 257-2. 981,P < 0. 05),and combined use of antibiotics( OR = 3. 429,95% CI: 2. 049-5. 736,P < 0. 05) were independent risk factors for MDRO infection in patients with chronic calculous cholecystitis,while traditional Chinese medicine treatment( OR = 0. 640,95% CI: 0. 433-0. 945,P < 0. 05) and cholagogic treatment( OR = 0. 548,95% CI: 0. 354-0. 847,P < 0. 05) were independent protective factors against MDRO infection in patients with chronic calculous cholecystitis. Conclusion The risk of MDRO infection in patients with chronic calculous cholecystitis can be reduced by rational use of antibiotics,auxiliary cholagogic and traditional Chinese medicine treatment,reduction in combined and repeated use of antibiotics,early surgical treatment in case of indications such as stone incarceration,and avoidance of gallbladder atrophy and polyps caused by long-term recurrent infection.
- cholecystitis /
- multidrug resistant bacteria /
- infection

HTML全文

参考文献(17)

[1] TAZUMA S,UNNO M,IGARASHI Y,et al. Evidence-based clinical practice guidelines for cholelithiasis 2016[J]. J Gastroenterol,2017,52(3):276-300.

[2] LU QP. Controversy and consensus of reserve or removal gall bladder for chronic cholecystitis and gallstone[J]. Chin J Pract Surg,2015,35(1):49-53.(in Chinese)卢绮萍．慢性胆囊炎胆囊结石行保留及切除胆囊的争议与共识[J]．中国实用外科杂志，2015,35(1):49-53.

[3] LEE CS,DOI Y. Therapy of infections due to carbapenemresistant gram-negative pathogens[J]. Infect Chemother,2014,46(3):149-164.

[4] Editorial Board of Chinese Journal of Digestion,Cooperation Group of Hepatobiliary Diseases of Chinese Society of Gastroenterology. Consensus on diagnosis and treatment of chronic cholecystitis and gallstones in China(2018)[J]. J Clin Hepatol,2019,35(6):1231-1236.(in Chinese)中华消化杂志编辑委员会，中华医学会消化病学分会肝胆疾病协作组．中国慢性胆囊炎、胆囊结石内科诊疗共识意见(2018年)[J]．临床肝胆病杂志，2019,35(6):1231-1236.

[5] HUANG X,DENG ZD,NI YX,et al. Chinese experts’consensus on prevention and control of multidrug resistance organism healthcare-associated infection[J]. Chin J Infect Control,2015,14(1):1-9.(in Chinese)黄勋，邓子德，倪语星，等．多重耐药菌医院感染预防与控制中国专家共识[J]．中国感染控制杂志，2015,14(1):1-9.

[6] State Health and Family Planning Commission of the People’s Republic of China Medical Administration and Health Administration. National clinical test operation procedures(4th Edition)[M]. Beijing:People’s Health Press,2015.(in Chinese)中华人民共和国国家卫生和计划生育委员会医政医管局．全国临床检验操作规程(第4版)[M]．北京:人民卫生出版社，2015.

[7] PANG SC,WU GZ,HUANG YH. Bile culture and drug sensitivity analysis in patients undergoing cholecystectomy[J]. J Hepatopancreatobiliary Surg,2019,31(8):489-492.(in Chinese)庞绍春，吴国忠，黄永亨．胆囊切除术患者胆汁培养和药敏分析[J]．肝胆胰外科杂志，2019,31(8):489-492.

[8] HU JL,PENG YL. The value of bile culture and drug sensitivity analysis in the use of antibiotics in cholecystectomy[J]. J Hepatopancreatobiliary Surg,2018,30(3):77-79.(in Chinese)胡金灵，彭永兰．胆汁培养及药敏分析对胆囊切除术抗生素使用的价值[J]．肝胆胰外科杂志，2018,30(3):77-79.

[9] WANG J,YU QY,LIU H,et al. Distribution and drug resistance of pathogens isolated from bile specimens of patients with biliary tract infections[J]. Chin J Nosocomiol,2014,24(14):3431-3435.(in Chinese)王军，余清源，刘华，等．胆道感染患者胆汁病原菌分布及耐药性分析[J]．中华医院感染学杂志，2014,24(14):3431-3435.

[10] FAN CL,LI XS,FENG Y,et al. Clinical distribution and drug resistance of pathogenic bacteria in bile of patients with cholecystolithiasis and cholecystitis[J]. Pract Pharm Clin Remedies,2019,22(7):762-767.(in Chinese)范陈良，李小四，冯燕，等．胆囊结石伴胆囊炎患者胆汁中病原菌临床分布及耐药性分析[J]．实用药物与临床，2019,22(7):762-767.

[11] SWEARINGEN MC,GRANGER JF,SULLIVAN A,et al. Elution of antibiotics from poly(methyl methacrylate)bone cement after extended implantation does not necessarily chear the infection despite susceptibility of the chinical isolates[J].Pat Dis,2016,74(1):103-105.

[12] ABODAKPI H,CHAMG KT,GSO S,et al. Optimal piperacillintazobactam dosing strstegies against extended-spectrum-β-lac-tamase-producing Enterobacteriaceae[J]. Antimicrob Agents Chemother,2019,63(2):e01906-e1918.

[13] VUOTTO C,LONGO F,PASCOLINI C,et al. Biofilm formation and antibiotic resistance in Klebsiella pneumoniae urinary strains[J]. J Appl Microbiol,2017,123(4):1003-1018.

[14] Editorial Board of Chinese Journal of Digestion. Chinese consensus on the medical diagnosis and treatment of chronic cholecystitis and gallstones(2014,Shanghai)[J]. J Clin Hepatol,2015,31(1):7-11.(in Chinese)中华消化杂志编辑委员会．中国慢性胆囊炎、胆囊结石内科诊疗共识意见(2014，上海)[J]．临床肝胆病杂志，2015,31(1):7-11.

[15] Spleen and Stomach Disease Branch of Chinese Medicine Association. Consensus opinions of experts in TCM diagnosis and treatment of cholecystitis(2017)[J]. Chin J Integr Trad West Med Dig,2017,25(4):241-246.(in Chinese)中华中医药学会脾胃病分会．胆囊炎中医诊疗专家共识意见(2017)[J]．中国中西医结合消化杂志，2017,25(4):241-246.

[16] XUE J,CHEN F,WANG J,et al. Emodin protects against concanavalin A-induced hepatitis in mice through inhibiting activation of the p38 MAPK-NF-kappaB signaling pathway[J]. Cell Physiol Biochem,2015,35(4):1557-1570.

[17] ZHAO H,LI S,ZHANG H,et al. Saikosaponin A protects against experimental sepsis via inhibition of NOD2-mediated NF-kappaB activation[J]. Exp Ther Med,2015,10(2):823-827.

施引文献

资源附件(0)

访问统计