262例胆管梗阻合并急性胆道感染患者胆汁病原菌学及耐药性变异分析

Analysis of Bile Pathogens and Drug‑Resistance Variation in 262 Patients with Biliary Obstruction Complicated with Acute Biliary Tract Infection

摘要: 目的：探讨胆管梗阻合并急性胆道感染患者胆汁中病原菌的相关特点，为临床抗生素的应用疗效进行分析。方法：研究通过回顾性统计分析，于2021年1月1日至2025年12月31日期间，青岛大学附属医院262例进行了ERCP治疗胆总管梗阻并急性胆道感染患者病例，重点研究胆汁细菌培养结果、菌种鉴定及药物敏感性测试，旨在探索胆汁中病原菌的变化及其耐药性的变化。利用卡方测试的方法进行数据统计和分析研究。结果：统计数据显示，从2021年至2025年，共有262例胆总管梗阻合并胆道感染患者送胆汁至检验科进行相关培养，培养检测的总体阳性率达90.45% (237例检测结果为阳性)。自2021年至2025年，胆汁标本培养病原菌阳性检出比例分别为89.47% (34/38)、88.09% (37/42)、88.70% (55/62)、92.06% (58/63)和92.98% (53/57)。不同组别阳性检出水平对比差异有统计学意义(χ² = 10.58, P = 0.027)。结论：2021年至2025年期间，伴随胆总管梗阻和胆道感染的患者中，胆汁培养的阳性率总体呈上升趋势。分离所得致病菌主要为革兰阴性杆菌，革兰阳性球菌检出频次较高。细菌谱发生了显著变化，临床医生应根据细菌谱的动态变化和抗药性调整抗菌药物的使用策略。

Abstract: Objective: To investigate the microbial profile in bile cultures from patients experiencing common bile duct obstruction paired with biliary tract infections, aiming to support clinical enhancement of antibiotic usage strategies. Methods: Between January 1, 2021, and December 31, 2025, at the Affiliated Hospital of Qingdao University, 262 individuals diagnosed with biliary obstruction and tract infections underwent endoscopic retrograde cholangiopancreatography. Bile specimens were collected for bacterial culture, identification of strain types, and antibiotic sensitivity testing. The analysis focused on the distribution, trends, and resistance of pathogenic bacteria in bile samples. Statistical evaluation employed the chi-square test. Results: Between 2021 and 2025, the cumulative positivity rate of bile cultures in 262 individuals diagnosed with choledocholithiasis accompanied by biliary tract infections reached 90.45% (237 out of 262). From 2021 to 2025, bile culture positivity rates were 89.47% (34/38), 88.09% (37/42), 88.70% (55/62), 92.06% (58/63), and 92.98% (53/57), respectively, with statistically significant differences (χ² = 10.58, P = 0.027). Conclusions: Between 2021 and 2025, the incidence of positive bile cultures in individuals with choledocholithiasis accompanied by biliary tract infections exhibited a general upward trajectory. Gram-negative rods remained the predominant pathogens in bile, but there was a noticeable rise in the presence of Gram-positive cocci. Additionally, the spectrum of bile-associated bacteria underwent substantial alterations. Healthcare providers must tailor antibiotic dosing schedules based on changes in bacterial profiles and resistance patterns.