| Objective:To observe the distribution of bile and blood pathogens in patients with obstructive jaundice,and to detect the sensitivity of antimicrobial agents and guide the use of antibiotics in clinical norms.Methods:A total of 322 patients with obstructive jaundice who were admitted to Department of Gastroenterology and Department of Hepatobiliary Surgery in Binzhou medical university affiliated hospital from January 2012 to April 2016 were enrolled.Bile samples were obtained from all patients and blood culture was performed for 84 patients.Analyzing the difference of bacteria positive culture rate between benign obstruction and malignant obstruction.Meanwhile,analyzing the difference between endoscopic retrograde cholangiopancreatography(ERCP)and surgial operation.All bile and blood samples are perfect general bacteria,anaerobic bacteria and fungal examination,calculate the results of drug susceptibility test.And to compare the positive culture rate of pathogenic bacteria in bile and blood.The same period in 322 patients with preoperative experience in the selection of antimicrobial drugs to complete the statistical understanding of the situation.Results:Pathogenic bacteria were detected in 246 patients(246/322),resulting in a detection rate of 76.40%.The bacteria positive culture rate in the patients by ERCP was 77.73%,and that by surgical operation was 71.21%(P>0.05).The bacteria positive culture rate in the benign ostruction patients was 74.65%,and that in the malignant obstruction patients was 91.18%.There was a significant difference in the detection rate of pathogenic bacteria between these two groups(P<0.05);There was no significant difference in the distribution of pathogenic bacteria between these two groups(P>0.05).At the same time,bile and blood culture in 84 patients,the bacteria positive culture rate of bile was 75%,and that of blood culture was 57.14%(P<0.01).A number of 267 strains were detected in bile sample,which consisted of 208 strains of Gram-negative bacteria,48 strains of Gram-positive bacteria,and 11 strains of fungi.Among the top 3 pathogens were Escherichia coli(142 strains,53.18%),Enterococcus faecium(28 strains,10.49%),Klebsiella pneumoniae(27 strains,10.11%).Gram-negative bacteria were most sensitive in imipenem and meropenem.(sensitivity 98.08%),followed by cefoperazone/sulbactam,amikacin and piperacillin/tazobactam sensitive,(sensitivity 92.31%,88.46%,85.58%),and the sensitivity of levofloxacin and aztreonam was the last(sensitivity 29.81%,28.37%).Gram-positive bacteria in linezolid,teicoplanin,vancomycin,the highest sensitivity(sensitivity 100%),followed by chloramphenicol(sensitivity 88.89%),levofloxacin less sensitive(sensitivity 25.00%).The number of empirical antibiotics of the 322 cases prior was 281.219 selected an antibacterial drug antibacterial treatment to levofloxacin(86/219)mostly,the second was cefoperazone/sulbactam(70/219).62 combined with antibacterial treatment,with cefoperazone/sulbactam plus o/metronidazole(27/62)majority,the second was levofloxacin plus ornidazole(12/62).Conclusions:1.Both in the benign obstruction patients and malignant obstruction patients,gram negative bacteria were the predominant bile pathogens.Cefoperazone/sulbactam,amikacin,piperacillin/tazobactam recommended for the first choice of antimicrobials,imipenem,meropenem in severe infection or the aforementioned antimicrobial treatment was no significant improvement recommended.2.The difference between ERCP and surgial operation had no statistical sig nificance(P>0.05).3.The bacteria positive culture rate in the malignant obstruction was overweigh that in the benign obstruction.4.Levofloxacin empirical drug use is still high,the clinical need to cancel the continued application.5.The positive rate of pathogenic bacteria in blood culture was lower than that in bile culture,but it was the similar with the type of bile culture pathogenic bacteria,which could be used for empirical treatment. |
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