PTCD术后胆道感染的主要病原菌类型及药敏试验的临床分析

发布时间：2018-07-02 21:39

  本文选题：PTCD + 胆道感染　； 参考：《青海大学》2017年硕士论文

【摘要】：目的:统计并分析青海大学附属医院所在地区因梗阻性黄疸(MOJ)行经皮肝穿刺胆道引流术(PTCD)治疗术后胆道感染患者胆汁中的主要病原菌的分布情况及其对不同抗生素的敏感情况,为本地区该类疾病临床用药提供指导。方法:1.样本采集:a术中:患者术前严格消毒、铺巾,按照PTCD常规手术流程于DSA下进行穿刺,穿刺成功后用20ml一次性针筒连接穿刺针并抽取15-20ml标本即刻送检,做细菌+真菌培养及药敏试验以备对比;b术后:对于术后出现感染的患者,采用20ml一次性无菌针管连接PTCD引流管,负压抽取15-20ml胆汁样本,并立即送检。2.标本培养:胆汁采样,立即将标本接种至血平板,时间2h,再将血平板置于37℃恒温箱培养12h-24h,分离纯化标准参照卫生部临床检验中心《检验操作规程》。3.检测方法:进行细菌种类鉴定所需的G-菌鉴定卡GNI及G+菌鉴定卡GPI均来自法国的VITEK-32细菌自动分析系统;并采用VITEK-32型全自动微生物分析仪的专用药敏卡对病原菌的耐药性进行检测。4.数据处理:运用Excel表格建立数据库;并用世界卫生组织推荐使用于细菌耐药性监测的WHONET统计软件对所得结果进行一般描述性分析。结果:(1)本试验共采集胆汁样本219例,培养所获得菌株数共253株,含20个种类,其中G-菌194株(76.7%),G+菌共53株(20.9%),真菌6株(2.4%);G-菌前三位分别为大肠杆菌93株(36.7%)、肺炎克雷伯杆菌39株(15.4%)、铜绿假单胞菌18株(7.1%),G+菌排名前两位的分别为屎肠球菌17株(6.7%)、粪肠球菌14株(5.5%);真菌以白色假丝酵母菌为主,共3株(1.2%);(2)对G-菌敏感性较高的抗菌药物包括碳青霉烯类、氨基糖苷类及头孢类抗生素;对G+菌敏感性较高的抗菌药物包括喹诺酮类、恶唑烷酮类及糖苷类抗生素;真菌对三唑类抗真菌药物均保持敏感。结论:1.我院所在地区因梗阻性黄疸行PTCD治疗术后胆道感染的患者胆汁中的病原菌以G-菌为主,其次为G+菌和真菌,部分病例为混合型感染。2.临床治疗该类疾病时,经验性用药首选G-菌敏感的抗菌药,对于感染程度较轻的患者,因阿米卡星肾毒性较大,应先选用头孢西丁和(或)哌拉西林/他唑巴坦。对于感染较重的患者选用亚胺培南,用药3天后,如感染控制不理想,提示G+菌或合并G+菌感染的可能,此时改用或者联合使用G+菌敏感的抗生素,如环丙沙星、利奈唑胺,病情较重的患者可选用万古霉素,如2周后感染仍不缓解,则考虑合并真菌感染,此时加用抗真菌药物,如氟康唑、氟胞嘧啶、伊曲康唑或伏立康唑。
[Abstract]:Objective: to analyze the distribution of main pathogenic bacteria in bile of patients with biliary tract infection after percutaneous transhepatic biliary drainage (PTCD) for obstructive jaundice (MOJ) in the affiliated hospital of Qinghai University. To provide guidance for the clinical use of this kind of disease in this area. Method 1: 1. Sample collection: the patient was sterilized strictly before operation, laid a towel, punctured under DSA according to the routine procedure of PTCD operation. After the puncture was successful, the needle was connected with 20ml disposable syringe and the 15-20ml specimen was taken for examination immediately. Bacterial fungus culture and drug sensitivity test were used for comparison after operation: for the patients with postoperative infection, 20ml was used to connect the 15-20ml drainage tube with a single sterile needle, and the samples of 15-20ml bile were taken by negative pressure, and the samples were immediately submitted to the patients. 2. Sample culture: sample bile, immediately inoculate the sample to blood plate for 2 hours, then culture blood plate in 37 鈩，

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