胆总管结石合并急性胆管炎患者PTCD胆汁与血培养病原菌分布及耐药性分析
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摘要
目的探讨胆总管结石合并急性胆管炎患者经皮肝穿刺胆道引流胆汁、血培养病原菌分布及抗菌药物合理用药情况。方法选取2014年8月-2017年8月就诊于本院的急性胆管炎且经磁共振胰胆管造影(MRCP)或者上腹部CT证实存在结石的患者共148例作为本次研究对象,其中取96例患者胆汁标本进行病原菌培养检测;取52例患者血液标本进行病原菌培养检测,同时对所培养的病原菌进行药敏试验,分析胆总管结石并胆管炎患者抗菌药物的应用合理性。结果胆汁样本检测的96例患者,共培养出病原菌120株,其中革兰阳性菌25株(20.83%),革兰阴性菌90株(75.00%),真菌5株(4.17%),行血液样本检测的52例患者,共培养出病原菌68株,其中革兰阳性菌19株(27.94%),革兰阴性菌49株(72.06%),病原菌检测提示,革兰阴性菌是引起急性胆管炎的主要致病菌。结论胆总管结石合并急性胆管炎患者病原菌检测操作方便,及早进行有利于医师制定诊疗计划,采用针对性抗菌药物治疗可有效提升治疗效果,减少耐药菌产生。
OBJECTIVE To explore the distribution of pathogens isolated from percutaneous transhepatic biliary drainage bile and blood specimens of choledocholithiasis patients complicated with acute cholangitis.METHODS A total of 148 patients with acute cholangitis who were treated in the hospital and were diagnosed with calculi through magnetic resonance cholangiopancreatography(MRCP)or upper abdominal CT were recruited as the study objects,the bile specimens were collected from 96 patients,and blood specimens were collected from 52 patients,the drug susceptibility testing was performed for the isolated pathogens,and the rationality of use of antibiotics was observed.RESULTS Totally 120 strains of pathogens were isolated from the bile specimens of the 96 patients,25(20.83%)of which were gram-positive bacteria,90(75.00%)were gram-negative bacteria.Totally 68 strains of pathogens were isolated from the blood specimens of 52 patients,19(27.94%)of which were gram-positive bacteria,and 49(72.06%)were gram-negative bacteria.The result of detection of pathogens indicated that the gram-negative bacteria are dominant among the pathogens causing the acute cholangitis.CONCLUSIONIt is simple to detect pathogens for the choledocholithiasis patients complicated with acute cholangitis,which may facilitate the development of treatment plans;the targeted drug therapy may improve the curative effect and reduce the drug-resistant strains.
OBJECTIVE To explore the distribution of pathogens isolated from percutaneous transhepatic biliary drainage bile and blood specimens of choledocholithiasis patients complicated with acute cholangitis.METHODS A total of 148 patients with acute cholangitis who were treated in the hospital and were diagnosed with calculi through magnetic resonance cholangiopancreatography(MRCP)or upper abdominal CT were recruited as the study objects,the bile specimens were collected from 96 patients,and blood specimens were collected from 52 patients,the drug susceptibility testing was performed for the isolated pathogens,and the rationality of use of antibiotics was observed.RESULTS Totally 120 strains of pathogens were isolated from the bile specimens of the 96 patients,25(20.83%)of which were gram-positive bacteria,90(75.00%)were gram-negative bacteria.Totally 68 strains of pathogens were isolated from the blood specimens of 52 patients,19(27.94%)of which were gram-positive bacteria,and 49(72.06%)were gram-negative bacteria.The result of detection of pathogens indicated that the gram-negative bacteria are dominant among the pathogens causing the acute cholangitis.CONCLUSIONIt is simple to detect pathogens for the choledocholithiasis patients complicated with acute cholangitis,which may facilitate the development of treatment plans;the targeted drug therapy may improve the curative effect and reduce the drug-resistant strains.
引文
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[2]陈鹏飞,任建庄,韩新巍,等.经皮肝穿刺胆道引流治疗急性梗阻性化脓性胆管炎合并感染性休克的疗效分析[J].介入放射学杂志,2016,25(12):1069-1072.
[3]Reuken PA,Torres D,Baier M,et al.Risk factors for multi-drug resistant pathogens and failure of empiric first-line therapy in acute cholangitis[J].PLoS One,2017,12(1):e0169900.
[4]孙媛媛,边赛男,张奉春.原发性胆汁性胆管炎并发浆细胞病患者临床特点[J].中华临床免疫和变态反应杂志,2017,11(2):126-130.
[5]克拉维恩.胆道疾病的诊断与治疗[M].北京,人民卫生出版社,2009,35-42.
[6]张卓然.临床微生物学和微生物检验-第3版[M].北京,人民卫生出版社,2003,22-29.
[7]中华医学会肝病学分会.原发性胆汁性肝硬化(又名原发性胆汁性胆管炎)诊断和治疗共识(2015)[J].中华传染病杂志,2016,20(7):960-968.
[8]Wang JJ,Yang GX,Zhang WC,et al.Escherichia coli infection induces autoimmune cholangitis and anti-mitochondrial antibodies in non-obese diabetic(NOD).B6(Idd10/Idd18)mice[J].Clin Exp Immunol,2014,175(2):192-201.
[9]Gidwaney NG,Pawa S,Das KM.Pathogenesis and clinical spectrum of primary sclerosing cholangitis[J].World J Gastroenterol,2017,23(14):2459-2469.
[10]Yu JH,Tang HJ,Zhang WG,et al.Catheterization of the gallbladder:a novel mouse model of severe acute cholangitis[J].World J Gastroenterol,2017,23(10):1771-1779.