胆石症致胆道感染病原菌谱变迁与耐药性的 现状及临床启示

Evolution of Pathogens Spectrum and Resistance Patterns in Biliary Tract Infections Caused by Cholelithiasis: Current Status and Clinical Implications

摘要: 胆石症是胆道感染的重要危险因素，其引起的胆道梗阻和炎症是导致感染发生和发展的关键机制。近年来随着全球范围内抗生素的不合理使用、侵入性医疗操作的普及以及人口老龄化加剧，胆道感染的病原菌构成及其对抗生素的敏感性正经历显著而动态的变化。这种病原谱与耐药性的变迁，直接挑战了传统经验性治疗方案的有效性，可能导致初始治疗失败、病程延长、医疗费用增加及患者死亡率上升。因此，本综述旨在梳理胆道感染病原菌的演变历史，深入分析当前耐药现状，对于指导临床精准抗感染治疗、改善患者预后具有至关重要的现实意义。

Abstract: Cholelithiasis constitutes a significant risk factor for biliary tract infections, with biliary obstruction and inflammation serving as key mechanisms in the initiation and progression of such infections. In recent years, the global increase in inappropriate antibiotic use, the widespread adoption of invasive medical procedures, and the growing aging population have led to notable and dynamic shifts in the composition of causative pathogens and their antibiotic susceptibility profiles in biliary tract infections. These evolving pathogen spectra and resistance patterns directly challenge the effectiveness of conventional empirical treatment regimens, potentially resulting in initial therapeutic failure, prolonged disease course, increased healthcare costs, and higher patient mortality. Therefore, this review aims to outline the historical evolution of pathogens in biliary tract infections and provide an in-depth analysis of the current status of antimicrobial resistance, which holds significant practical implications for guiding precise clinical anti-infective therapy and improving patient prognosis.