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恶性胆道梗阻经皮胆道引流或支架置入术后感染的病原学特征
DOI: 10.3969/j.issn.1001-5256.2022.06.024
利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。
作者贡献声明：李智、倪才方、邹建伟负责课题设计，撰写论文并最后定稿; 李思茵、焦冰珂、洪祈源、姜小庆负责收集数据，资料分析。
Etiological characteristics of infection after percutaneous biliary drainage or stent implantation for malignant biliary obstruction
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摘要:
目的 探讨恶性胆道梗阻(MBO)患者经皮胆道引流或支架置入术后感染的病原学特征。 方法 收集2016年1月—2020年12月在苏州大学附属第一医院介入科接受介入治疗后存在或怀疑胆道感染、送检胆汁培养和/或无同期血培养的MBO患者的临床资料。从病原学培养的阳性率、菌群分布、血培养与胆汁培养的一致性、主要致病菌的耐药率方面进行分析。 结果 共纳入患者219例，胆汁病原学培养阳性105例(47.95%)，其中革兰氏阴性菌、革兰氏阳性菌、真菌的构成比分别为64.89%、28.24%、6.87%。同期送检血培养者69例，阳性33例(47.82%)。血培养和胆汁培养同为阳性的患者25例，一致性分析结果显示，完全一致占36%(9/25)，部分一致占20%(5/25)，完全不一致占44%(11/25)。常见致病的革兰氏阴性菌为大肠埃希菌、肺炎克雷伯、阴沟肠杆菌，对其耐药率(＜15%)较低的抗生素有头孢哌酮/舒巴坦、阿米卡星、亚胺培南。常见致病的革兰氏阳性菌为屎肠球菌、粪肠球菌，对其耐药率较低的抗生素有万古霉素、利奈唑胺、替考拉宁。 结论 MBO患者经皮胆道引流或支架置入术后感染的常见致病菌为大肠埃希菌、肺炎克雷伯、肠球菌、阴沟肠杆菌。血培养与胆汁培养的一致性较低，均应积极送检。 Abstract:Objective To investigate the etiological characteristics of infection after percutaneous biliary drainage or stent implantation in patients with malignant biliary obstruction (MBO). Methods Clinical data were collected from MBO patients who underwent interventional therapy in Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, from January 2016 to December 2020 and had or were suspected of biliary tract infection, with samples submitted for bile culture and/or simultaneous blood culture. Analysis was performed for the aspects of positive rate of culture, flora distribution, consistency between blood culture and bile culture, and drug resistance rate of major pathogenic bacteria. Results A total of 219 patients were enrolled, among whom 105(47.95%) were positive for bile culture, and the composition ratios of Gram-negative bacteria, Gram-positive bacteria, and fungi were 64.89%, 28.24%, and 6.87%, respectively. A total of 69 patients had samples submitted for blood culture during the same period of time, among whom 33(47.82%) had positive results. Positive results of both bile culture and blood culture were observed in 25 patients, and consistency analysis showed that the patients with complete consistency, partial consistency, and complete inconsistency accounted for 36%(9/25), 20%(5/25), and 44%(11/25), respectively. Common Gram-negative bacteria were Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae, with a relatively low level of drug resistance to antibiotics including cefoperazone/sulbactam, amikacin, and imipenem. Common Gram-positive bacteria were Enterococcus faecium and Enterococcus faecalis, with a relatively low level(< 15%) of drug resistance to antibiotics including vancomycin, linezolid, and teicoplanin. Conclusion Common pathogens of infection after percutaneous biliary drainage or stent implantation in MBO patients include Escherichia coli, Klebsiella pneumoniae, Enterococcus, and Enterobacter cloacae. There is a relatively low level of consistency between blood culture and bile culture, and thus samples should be submitted for both tests. -
图 1 胆汁培养最常见10种菌的构成比
Figure 1. Composition ratios of the 10 most common species of bacteria in bile cultures
图 2 血培养最常见5种菌的构成比
Figure 2. Composition ratios of the 5 most common species of bacteria in blood cultures
表 1 胆汁培养及血培养主要革兰阴性菌耐药率
Table 1. Drug resistance rate of major gram-negative bacteria in bile and blood cultures
药品 胆汁培养(%) 血培养(%) 大肠埃希菌
(n=18)肺炎克雷伯
(n=23)阴沟肠杆菌
(n=3)大肠埃希菌
(n=9)肺炎克雷伯
(n=5)阴沟肠杆菌
(n=5)头孢曲松 88.89 65.22 66.67 66.67 60.00 60.00 头孢唑啉 72.22 56.52 66.67 66.67 60.00 80.00 环丙沙星 72.22 60.87 33.33 55.56 40.00 20.00 复方新诺明 72.22 56.52 66.67 44.44 40.00 60.00 哌拉西林 66.67 56.52 33.33 66.67 60.00 60.00 氨苄西林 66.67 65.22 66.67 77.78 100.00 60.00 头孢他啶 44.44 43.48 33.33 33.33 40.00 60.00 头孢吡肟 38.89 30.43 33.33 33.33 60.00 20.00 亚胺培南 33.33 34.78 33.33 0 0 20.00 头孢哌酮/舒巴坦 5.56 13.04 33.33 0 0 20.00 阿米卡星 0 4.35 0 11.11 0 0 
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表 2 胆汁培养主要革兰阳性菌耐药率
Table 2. Drug resistance rate of major gram-positive bacteria in bile cultures
药品 屎肠球菌(%)
(n=8)粪肠球菌(%)
(n=7)环丙沙星 75.00 0 青霉素 62.50 0 氨苄西林 62.50 0 四环素 50.00 71.43 利奈唑胺 12.50 0 万古霉素 0 0 替考拉宁 0 0
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