Chen Shayan, Lai Wenbin, Song Xuejing, Lu Jiongtang, Liang Jianxin, Ouyang Hao, Zheng Weihua, Chen Jianjun, Yin Zhenggang, Li Huimin, Zhou Yong
Department of Laboratory Science, Binhaiwan Central Hospital of Dongguan, Guangdong, China.
Dongguan Key Laboratory of Accurate Etiological Research on the Pathogenesis of Inflammation and Cancer, Guangdong, China.
Front Microbiol. 2024 May 9;15:1404366. doi: 10.3389/fmicb.2024.1404366. eCollection 2024.
Biliary Infection in patients is a common and important phenomenon resulting in severe complications and high morbidity, while the distributions and drug resistance profiles of biliary bacteria and related risk factors are dynamic. This study explored the characteristics of and risk factors for biliary infection to promote the rational use of antibiotics in clinically.
Bacterial identification and drug susceptibility testing were completed using the Vitek 2 Compact analysis system. The distribution and antibiotic-resistant characteristics of 3,490 strains of biliary bacteria in patients at Nankai Hospital from 2019 to 2021 were analyzed using Whonet 5.6 and SPSS 26.0 software. We then retrospectively analyzed the clinical data and risk factors associated with 2,340 strains of Gram-negative bacilli, which were divided into multidrug-resistant bacteria (1,508 cases) and non-multidrug-resistant bacteria (832 cases) by a multivariate Cox regression model.
A total of 3,490 pathogenic bacterial strains were isolated from bile samples, including 2,340 (67.05%) Gram-negative strains, 1,029 (29.48%) Gram-positive strains, and 109 (4.56%) fungal strains. The top five pathogenic bacteria were , , , , and . The rate of resistance to ciprofloxacin increased ( < 0.05), while the resistance to amikacin decreased ( < 0.05). The resistance of to cephalosporins, carbapenems, -lactamase inhibitors, cephalases, aminoglycosides, and quinolones increased ( < 0.05), and the resistance of to piperacillin, piperacillin/tazobactam, ticacillin/clavulanic acid, and amicacin declined significantly ( < 0.05). The resistance of to tetracycline increased by year ( < 0.05), and the resistance of to erythromycin and high-concentration gentamicin declined ( < 0.05). Multivariate logistic regression analysis suggested that the administration of third- or fourth-generation cephalosporins was an independent risk factor for biliary infection. In summary, Gram-negative bacilli were the most common pathogenic bacteria isolated from biliary infection patients, especially , and the rates and patterns of drug resistance were high and in constant flux; therefore, rational antimicrobial drug use should be carried out considering risk factors.
患者的胆道感染是一种常见且重要的现象，会导致严重并发症和高发病率，而胆道细菌的分布、耐药谱及相关危险因素是动态变化的。本研究探讨胆道感染的特征及危险因素，以促进临床上抗生素的合理使用。
使用Vitek 2 Compact分析系统完成细菌鉴定和药敏试验。运用Whonet 5.6和SPSS 26.0软件分析2019年至2021年南开医院患者3490株胆道细菌的分布及耐药特征。然后回顾性分析2340株革兰氏阴性杆菌的临床资料及相关危险因素，通过多变量Cox回归模型将其分为多重耐药菌（1508例）和非多重耐药菌（832例）。
共从胆汁样本中分离出3490株病原菌，其中革兰氏阴性菌2340株（67.05%）、革兰氏阳性菌1029株（29.48%）、真菌109株（4.56%）。前五位病原菌为 、 、 、 、 。对环丙沙星的耐药率上升（ ＜0.05），而对阿米卡星的耐药率下降（ ＜0.05）。 对头孢菌素、碳青霉烯类、β-内酰胺酶抑制剂、头孢酶、氨基糖苷类和喹诺酮类的耐药性增加（ ＜0.05），而对哌拉西林、哌拉西林/他唑巴坦、替卡西林/克拉维酸和阿米卡星的耐药性显著下降（ ＜0.05）。 对四环素的耐药性逐年增加（ ＜0.05），而对红霉素和高浓度庆大霉素的耐药性下降（ ＜0.05）。多变量逻辑回归分析表明，使用第三代或第四代头孢菌素是胆道感染的独立危险因素。总之，革兰氏阴性杆菌是从胆道感染患者中分离出的最常见病原菌，尤其是 ，其耐药率和模式较高且不断变化；因此，应考虑危险因素合理使用抗菌药物。
