老年恶性胆道梗阻患者塑料支架阻塞物细菌学和抗生素耐药性分析

Analysis of Bacteriology and Antibiotic Resistance of Plastic Stent Obstruction in Elderly Patients with Malignant Biliary Obstruction

摘要: 目的：分析老年恶性胆道梗阻患者塑料支架阻塞物中细菌种类、分布特征以及药敏情况，为临床上合理选用抗生素提供参考。方法：共收集行内镜下胆道塑料支架更换的老年恶性胆道梗阻患者60例，对术中被更换的支架内腔的阻塞物行细菌培养与药敏试验，观察并分析其细菌分布特征及耐药情况。结果：60份阻塞物标本培养结果均为阳性，共分离培养出93株病原菌，革兰阴性杆菌61例(65.6%)，革兰阳性球菌30例(32.2%)，真菌2例(2.2%)。前五位细菌依次为大肠埃希菌21例(22.6%)、屎肠球菌15例(16.1%)、肺炎克雷伯菌13例(14.0%)、铜绿假单胞菌11例(11.8%)、粪肠球菌10例(10.8%)。药敏结果显示碳青霉烯类是针对革兰阴性菌最敏感的药物；屎肠球菌和粪肠球菌对亚胺培南、利奈唑胺及替考拉宁药物的敏感率高达100%，无耐药菌株产生。结论：老年恶性胆道梗阻患者支架阻塞物细菌培养阳性率高，以革兰阴性菌感染为主，肠球菌属检出率高于大肠埃希菌，经验性选用抗菌药时，应注意对革兰阴性杆菌及肠球菌属的覆盖。早期积极应用碳青霉烯类药物可以有效控制感染。无禁忌的情况下，应该及时更换支架，以便解除胆道梗阻。

Abstract: Objective: To analyze the bacterial species, distribution characteristics and drug sensitivity of plastic stent obstruction in elderly patients with malignant biliary obstruction, so as to provide reference for the rational selection of antibiotics in clinical practice. Methods: A total of 60 elderly patients with malignant biliary obstruction who had been replaced with plastic stent under endoscopy were collected. Bacterial culture and drug sensitivity test were performed on the obstruction in the stent cavity, and the bacterial distribution and drug resistance were observed and analyzed. Results: The culture results of 60 obstruction specimens were all positive. A total of 93 pathogenic bacteria were isolated and cultured, 61 cases of Gram-negative bacilli (65.6%), 30 cases of Gram- positive cocci (32.2%), and 2 cases of fungi (2.2%). The top five bacteria were 21 cases of Escherichia coli (22.6%), 15 cases of Enterococcus faecium (16.1%), 13 cases of Klebsiella pneumoniae (14.0%), and 11 cases of Pseudomonas aeruginosa (11.8%), 10 cases of Enterococcus faecalis (10.8%). Drug sensitivity results show that carbapenems are the most sensitive drugs against Gram-negative bacteria; Enterococcus faecium and Enterococcus faecalis are 100% sensitive to imipenem, linezolid, and teicoplanin, and no resistant strains were found. Conclusion: In the elderly patients with malignant biliary obstruction, the positive rate of bacterial culture of stent obstruction is high, mainly due to gram-negative bacterial infection, and the detection rate of Enterococcus is higher than that of Escherichia coli. When selecting antibacterial agents empirically, attention should be paid to the coverage of Gram-negative bacteria and Enterococcus. Early active use of carbapenems can effectively control infection. If there is no contraindication, the stent should be replaced in time to relieve biliary obstruction.