發(fā)布時間：2018-06-03 03:26

  本文選題：膽石癥 + 膽道感染��； 參考：《濱州醫(yī)學院》2015年碩士論文

【摘要】：目的：觀察膽石癥合并急性膽管炎患者膽汁及血液中病原菌的分布特征、培養(yǎng)陽性率及其二者的關系,并分析病原菌對抗菌藥物的敏感性,指導臨床合理選擇和應用抗菌藥物。方法：選取2011年1月至2015年2月本院消化內科診斷為急性膽道感染、經(jīng)內鏡逆行性胰膽管造影術(endoscopic retrograde cholangiopancreatography, ERCP),術中證實存在結石的120例患者的膽汁標本,所有膽汁標本均進行普通細菌、厭氧菌及真菌培養(yǎng),其中43例行血培養(yǎng),分別對其病原菌培養(yǎng)及藥敏結果進行分析,并探討膽汁培養(yǎng)與血培養(yǎng)二者的關系,同時對120例患者術前經(jīng)驗性應用的抗菌藥物進行統(tǒng)計分析。結果：120例膽汁培養(yǎng)者中87例檢出病原菌,陽性率為72.5%。膽汁標本中共分離出病原菌92株,其中革蘭陰性菌70珠,革蘭陽性菌18株,真菌4株,革蘭陰性菌中排名居前3位的細菌分別是大腸埃希菌(52株,56.5%)、克雷伯菌屬(6株,6.5%)、陰溝腸桿菌(4株,4.3%)。43例血培養(yǎng)者19例檢出病原菌,陽性率為44.1%。血培養(yǎng)中分離出病原菌19株,其中大腸埃希菌16株,肺炎克雷伯菌2株,梭桿菌屬1珠。膽汁中革蘭陰性菌對頭孢哌酮/舒巴坦、哌拉西林/他唑巴坦和阿米卡星敏感性較高(敏感率分別為94.3%、90.0%和84.3%),對左氧氟沙星敏感性最低(敏感率僅為22.9%),未發(fā)現(xiàn)對對亞胺培南及美羅培南耐藥者。120例患者術前均經(jīng)驗性應用抗菌藥物,68例應用單一抗菌藥物抗感染,主要為左氧氟沙星(41/68),其次為頭孢哌酮/舒巴坦(14/68)和其他(13/68)；52例兩聯(lián)抗感染治療,主要為左氧氟沙星+甲硝唑(20/52)、頭孢哌酮/舒巴坦+甲硝唑(18/52)和其他(14/52)。結論：1.膽石癥合并急性膽道感染患者膽汁中及血液中的主要病原菌為革蘭陰性菌,均以大腸埃希菌為主,且兩者在病原菌分布構成上無明顯差異。2.與既往認為膽道感染易合并厭氧菌感染不同,本實驗中未分離出厭氧菌。3.頭孢哌酮/舒巴坦、哌拉西林/他唑巴坦、阿米卡星敏感性較高,可作為膽石癥合并急性膽道感染的首選抗菌藥物,亞胺培南、美羅培南作為備選抗菌藥物,在嚴重感染或其他抗菌藥物無效下考慮使用。4.左氧氟沙星、氨曲南在膽道結石并膽道感染患者中耐藥率高,臨床上經(jīng)驗性應用抗菌藥物時應避免選用。
[Abstract]:Objective: to observe the distribution of pathogenic bacteria in bile and blood of patients with cholelithiasis complicated with acute cholangitis, the positive rate of culture and the relationship between them, and to analyze the sensitivity of pathogenic bacteria to antimicrobial agents, and to guide the rational selection and application of antimicrobial agents in clinic. Methods: from January 2011 to February 2015, 120 cases of choledocholithiasis confirmed by endoscopic retrograde cholangiopancreatography (ERCP) were diagnosed as acute biliary infection by endoscope retrograde cholangiopancreatography (ERCP). All bile samples were cultured with common bacteria, anaerobes and fungi, 43 of them were cultured in blood. The results of pathogen culture and drug sensitivity were analyzed, and the relationship between bile culture and blood culture was discussed. At the same time, 120 cases of preoperative experience of the use of antimicrobial agents were statistically analyzed. Results pathogenic bacteria were detected in 87 out of 120 cases of bile culture, and the positive rate was 72.5%. 92 strains of pathogenic bacteria were isolated from bile samples, including 70 beads of Gram-negative bacteria, 18 Gram-positive bacteria and 4 fungi. Among Gram-negative bacteria, 52 strains of Escherichia coli, 6 strains of Klebsiella, 4 strains of Enterobacter cloacae, 4 strains of Enterobacter cloacae and 43 cases of blood culture were found to be pathogenic bacteria, the positive rate was 44.1%. 19 strains of pathogenic bacteria were isolated from blood culture, including 16 strains of Escherichia coli, 2 strains of Klebsiella pneumoniae and 1 strain of Clostridium pneumoniae. Gram-negative bacteria in bile against cefoperazone / sulbactam, The sensitivity of piperacillin / tazobactam and amikacin was high (94.3% and 84.3%, respectively), and the sensitivity to levofloxacin was the lowest (the sensitivity rate was only 22.9%, no resistance to imipenem and meropenem was found in 0.120 cases before operation. 68 cases were treated with single antimicrobial agent, and 68 cases were treated with single antimicrobial agent against infection. Levofloxacin 41 / 68, cefoperazone / sulbactam 14 / 68) and other 13 / 68% of 52 cases were treated with levofloxacin metronidazole 20 / 52, cefoperazone / sulbactam / sulbactam 18 / 52) and other 14 / 52P. Conclusion 1. The main pathogenic bacteria in bile and blood of patients with cholelithiasis complicated with acute biliary tract infection were Gram-negative bacteria, which were mainly Escherichia coli, and there was no significant difference in the distribution of pathogenic bacteria between them. Different from the previous thought that biliary tract infection is easy to be complicated with anaerobic infection, no anaerobes. 3 were isolated in this experiment. Cefoperazone / sulbactam, piperacillin / tazobactam, amikacin are highly sensitive and can be used as the first choice of antimicrobial agents for cholelithiasis complicated with acute biliary tract infection, imipenem and meropenem as alternative antimicrobial agents. Consider using. 4 in the event of severe infection or other antimicrobial failure. Levofloxacin and aztreonam have high drug resistance in patients with cholelithiasis and biliary tract infection.
【學位授予單位】：濱州醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R575.6

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