胆结石患者术后感染病原菌特点及相关影响因素探讨
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摘要
目的分析胆结石患者术后感染病原菌特点及相关影响因素。方法选取2015年1月-2018年6月在本院行腹腔镜肝切除手术治疗的203例肝内胆管结石患者为研究对象,按术后是否发生感染分为胆结石术后感染组(93例)和胆结石术后未感染组(110例)。采集患者胆汁作细菌培养检查及药敏试验,并对引起胆结石术后感染的相关因素进行单因素分析,采用Logistic回归分析法筛选其中的保护因素。结果 93例胆结石术后感染患者共分离出101株细菌,其中革兰阴性菌73株(占72.28%),主要菌种大肠埃希菌和肺炎克雷伯菌对氨苄西林耐药率为80.0%和75.0%,对亚胺培南和哌拉西林/他唑巴坦敏感;革兰阳性菌22株(占21.78%),主要菌种尿肠球菌和粪肠球菌对克林霉素、磺胺甲恶唑/甲氧苄啶及头孢唑林耐药率为60.0%～87.5%,对万古霉素敏感;真菌6株(占5.94%)。胆结石术后发生感染的因素可能与采取预防措施、手术时间及胆汁总胆红素水平有关,其中预防措施为保护因素。结论胆结石患者术后感染的致病菌主要为革兰阴性菌,其对亚胺培南及哌拉西林/他唑巴坦敏感。采取相应预防措施为胆结石术后发生感染的保护因素,合理使用抗菌药物并采取针对性预防措施可减少术后细菌感染的发生。
Objectives To investigate the epidemiological characteristics of pathogens causing an infection after cholecystectomy and related factors influencing the development of that infection. Methods Subjects were 203 patients with intrahepatic bile duct stones who underwent laparoscopic hepatic resection at this Hospital from January 2015 to June 2018. Based on the development of an infection postoperatively, subjects were divided patients with an infection(93 patients) and patients without an infection(110 patients). Bile from patients was collected for bacterial culture and drug susceptibility testing. Factors related to development of an infection after gallstone surgery were subjected to univariate analysis. Factors for protection from development of an infection were analyzed using logistic regression analysis. Results A total of 101 strains of pathogens were isolated from 93 patients with an infection following gallstone surgery. Of the isolated strains, 73(72.28%) were strains of Gram-negative bacteria. The predominant strains of Escherichia coli and Klebsiella pneumoniae were 80.0% and 75.0% resistant to ampicillin and were more sensitive to imipenem and piperacillin/tazobactam. Of the isolated strains, 22(21.78%) were strains of Gram-positive bacteria, and the resistance of the predominant strains of Enterococcus faecalis and Enterococcus faecalis to clindamycin, sulfamethoxazole/trimethoprim, and cefazolin ranged from 60.0%-87.5%. Strains were more sensitive to cefacillin, imipenem, and piperacillin/tazobactam. Of the isolated strains, 5.94% were strains of fungi. The risk of infection after gallstone surgery may be related to preventive measures, operating time, and the total bilirubin level in bile. Preventive measures protect against the development of a postoperative infection. Conclusions Gram-negative bacteria were the main pathogens causing an infection after gallstone surgery. The bacteria are sensitive to cefacillin, imipenem, and piperacillin/tazobactam. Preventive measures are a factor protecting against the development of an infection after cholecystectomy. Rational use of antibiotics and preventive measures can prevent postoperative infections.
Objectives To investigate the epidemiological characteristics of pathogens causing an infection after cholecystectomy and related factors influencing the development of that infection. Methods Subjects were 203 patients with intrahepatic bile duct stones who underwent laparoscopic hepatic resection at this Hospital from January 2015 to June 2018. Based on the development of an infection postoperatively, subjects were divided patients with an infection(93 patients) and patients without an infection(110 patients). Bile from patients was collected for bacterial culture and drug susceptibility testing. Factors related to development of an infection after gallstone surgery were subjected to univariate analysis. Factors for protection from development of an infection were analyzed using logistic regression analysis. Results A total of 101 strains of pathogens were isolated from 93 patients with an infection following gallstone surgery. Of the isolated strains, 73(72.28%) were strains of Gram-negative bacteria. The predominant strains of Escherichia coli and Klebsiella pneumoniae were 80.0% and 75.0% resistant to ampicillin and were more sensitive to imipenem and piperacillin/tazobactam. Of the isolated strains, 22(21.78%) were strains of Gram-positive bacteria, and the resistance of the predominant strains of Enterococcus faecalis and Enterococcus faecalis to clindamycin, sulfamethoxazole/trimethoprim, and cefazolin ranged from 60.0%-87.5%. Strains were more sensitive to cefacillin, imipenem, and piperacillin/tazobactam. Of the isolated strains, 5.94% were strains of fungi. The risk of infection after gallstone surgery may be related to preventive measures, operating time, and the total bilirubin level in bile. Preventive measures protect against the development of a postoperative infection. Conclusions Gram-negative bacteria were the main pathogens causing an infection after gallstone surgery. The bacteria are sensitive to cefacillin, imipenem, and piperacillin/tazobactam. Preventive measures are a factor protecting against the development of an infection after cholecystectomy. Rational use of antibiotics and preventive measures can prevent postoperative infections.
引文
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[9] 李乔林,胡从兵,胡剑飞,等.肝内胆管结石手术切口感染的危险因素分析[J].中华医院感染学杂志,2016,26(9):2059-60.
[10] 张风华,彭和平,王宝枝,等.肝癌肝切除术后感染性并发症的危险因素分析[J].中国普通外科杂志,2015,24(1):133-5.
[11] 侯妙珍,赵明杏,牛剑祥,等.胆囊结石术后发生院内感染的危险因素及护理对策[J].中国医药导报,2015,12(36):160-3.
[2] Qiao O,Hu P,Jin Y.Hepatic lobectomy and segmental resection of liver for hepatolithiasis[J].West Indian Med J,2014,63(2) :176-8.
[3] Ma WJ,Zhou Y,Yang Q,et al.The puzzle and challenge in treating hepatolithiasis[J].Surg Laparosc Endosc Percutan Tech,2015,25(1):94-5.
[4] 毛长坤,刘付宝,赵义军,等.肝内胆管结石手术切口感染危险因素分析[J].中国普通外科杂志,2013,23(8):1049-54.
[5] 林宗梅,綦怀纲,余丹,等.胆结石患者胆道感染病原菌分布与药敏分析[J].中华医院感染学杂志,2015,25(8):1747-9.
[6] 中华人民共和国卫生部.医院感染诊断标准[J].中华医学杂志,2001,881(5):314-20.
[7] 马越,李景云,金少鸿.美国临床实验室标准委员会推荐药敏试验操作方法和判断标准(2005年修订版)[J].中华医学杂志,2005,85(17):1182-4.
[8] 王新玮,赵宗刚.肝内胆管结石患者肝切除术后感染性并发症发生的影响因素分析[J].临床肝胆病杂志,2017,33(9):1754-7.
[9] 李乔林,胡从兵,胡剑飞,等.肝内胆管结石手术切口感染的危险因素分析[J].中华医院感染学杂志,2016,26(9):2059-60.
[10] 张风华,彭和平,王宝枝,等.肝癌肝切除术后感染性并发症的危险因素分析[J].中国普通外科杂志,2015,24(1):133-5.
[11] 侯妙珍,赵明杏,牛剑祥,等.胆囊结石术后发生院内感染的危险因素及护理对策[J].中国医药导报,2015,12(36):160-3.