Analysis of biliary tract infections and anti-infection treatments on 101 cases of PTCD for malignant biliary obstruction
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摘要: 目的 了解恶性梗阻性黄疸患者行经皮肝脏穿刺胆道引流术（PTCD）术后胆道感染的主要病原菌分布及药物敏感性特点，以及不同抗菌药物对主要病原菌的治疗效果，为临床合理使用抗菌药物提供依据。 方法 对东方肝胆外科医院2013年9月至2014年10月收治的423例恶性梗阻性黄疸行PTCD治疗患者的临床资料进行回顾性调查，针对其中101例发生术后胆道感染的病例，分析细菌培养结果及耐药情况，评价抗菌药物治疗效果。 结果 101例患者术后发生胆道感染，67例细菌培养结果阳性，共培养出细菌94株，其中G-菌62株（65.96%），G+菌32株（34.04%），主要致病菌包括肺炎克雷伯杆菌、大肠杆菌、粪肠球菌和阴沟肠杆菌等。G-菌中肺炎克雷伯杆菌和大肠杆菌的耐药率较高；G-菌对亚胺培南、哌拉西林钠/他唑巴坦钠和阿米卡星耐药率较低；G+菌对达托霉素、万古霉素和利奈唑胺耐药率较低。我院PTCD术后感染治疗的总体有效率为88.1%，67例细菌培养结果为阳性的患者治疗有效率为97%。 结论 我院PTCD术后胆道感染的抗菌治疗基本合理。建议医生积极行标本细菌培养，根据药敏结果选择敏感抗菌药物。针对主要分离菌中的G-菌，头孢曲松耐药率高，治疗效果欠佳，建议医生减少头孢曲松的使用。对G+菌中的耐甲氧西林葡萄球菌（MRS），可使用糖肽类抗菌药物。
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关键词:
- 恶性梗阻性黄疸 /
- 经皮肝脏穿刺胆道引流术 /
- 胆道感染 /
- 病原学分析
Abstract: Objective To find out the main pathogenic bacteria distribution and sensitivity to antibiotics in patients post PTCD for malignant biliary obstruction, to evaluate the therapeutic effectiveness of antibiotics and provide evidences for rational use of antibiotics. Methods The clinical data were collected and analyzed retrospectively from 423 PTCD cases with malignant biliary obstruction from September 2013 to October 2014. Results Among 423 patients underwent PTCD, 101 patients were confirmed with infections. 67 patients showed positive pathogenic bacteria culture. A total of 94 strains of pathogenic bacteria were detected. There were 62 strains of gram negative bacteria (65.96%) and 32 strains of gram positive bacteria (34.04%). The main pathogenic bacteria were klebsiella pneumoniae, Escherichia coli, enterococcus faecalis and Enterobacter cloacae. Klebsiella pneumoniae and Escherichia coli are the two gram negative bacteria most resistant to antibiotics. The three popular gram negative bacilli in this study had the lowest resistance to imipenem/cilastatin, piperacillin/tazobactam and amikacin. The three main gram positive bacteria were most sensitive to daptomycin, linezolid and vancomycin. The total effective rate of antibiotic treatments for post PTCD infections was 88.1%. Conclusion Our hospital had an appropriate treatment plan with antibiotics to control the infections post percutaneous transhepatic cholangio-drainage for malignant biliary obstruction. According to the results of drug sensitivity test, ceftriaxone had high resistance rate. The outcome with ceftriaxone treatment was unsatisfactory. Clinical pharmacists should advise doctors to reduce the usage of ceftriaxone. Glycopeptide antibiotics can be used to control methicillin-resistant staphylococcus (MRS) gram positive bacteria.-
Key words:
- malignant obstructive jaundice /
- PTCD /
- biliary tract infection /
- etiological survey
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