Pathogenic Bacteriology Of Bile After Interventional Treatment Of Malignant Obstructive Jaundice And Analysis Of Related Factors Of Biliary Tract Infection

Objective: By analyzing the distribution and drug resistance of pathogenic bacteria in bile culture in patients with malignant obstructive jaundice after interventional therapy,this study obtained the positive rate of bile culture and the incidence of biliary tract infection,explored the risk factors and analyzed the use of antibiotics in biliary tract infection,in order to provide theoretical basis for the prevention and treatment of biliary tract infection after interventional therapy.Methods: Patients with malignant obstructive jaundice admitted to the Second Hospital of Lanzhou University from January 2018 to January 2022 were selected according to the sodium exclusion criteria.After admission,all patients received ENBD or PTCD interventional therapy to relieve jaundice,and bile obtained was timely examined for bile pathogen culture,and drug sensitivity test was also improved.In addition,data such as gender,age,combined with underlying diseases,prophylactic antibiotic use,obstruction plane,obstruction duration,interventional-therapy approach,primary malignant tumor type,preoperative serum total bilirubin,tumor markers CA199,CA125,ALT,AST,γ-GGT,ALP,serum albumin,Child-Pugh score of liver function,biliary tract infection and bile culture results were collected.To explore the risk factors of positive biliary culture and biliary tract infection after interventional therapy.Firstly,univariate analysis was used,and then the significant factors(P < 0.05)were further analyzed by Logistic regression,and finally the independent risk factors were obtained.Results:(1)Among 158 patients with malignant obstructive jaundice,73 patients had positive bile culture after interventional treatment,among which 7 patients had multiple strains of bile culture,that is,80 strains of pathogenic bacteria were cultured in bile.The isolated pathogens included 57 strains of Gram-negative bacteria(71%),19 strains of Gram-positive bacteria(24%)and 4 strains of fungi(5%),among which 16 strains(20%)were multidrug-resistant,including 10 cases of E.coli,3 cases of Grass green hemolytic streptococcus,1 case of Klebsiella pneumoniae,1 case of Pseudomonas aeruginosa and 1 case of Citricobacter flordii.(2)The resistance rate of Gram-negative bacteria to penicillin antibiotics such as Ampicillin and Amoxicillin was the highest,and the sensitivity to Amika-magnitude aminoglycoside antibiotics was the highest;The resistance rate of Gram-positive bacteria to Erythromycin and Penicillin was the highest,the sensitivity to Furantoin,Vancomycin,Tigacycline and high level of Gentamicin was the highest,and the resistance to other antibiotics showed different degrees.(3)Biliary tract infection occurred in 49 of the 73 patients with positive biliary culture after interventional therapy,with a positive rate of about 46% and an incidence of biliary tract infection of 31%.Logistic regression analysis was performed for the risk factors screened by univariate analysis(P < 0.05),and the results indicated that the independent risk factors for positive bile culture were ALT≥150 U/L,postoperative biliary tract infection,and interventional therapy ENBD and CA199≥270U/L.Obstruction duration ≥14 days,high obstruction and positive bile culture were independent risk factors for biliary tract infection in patients with malignant obstructive jaundice after interventional therapy(P < 0.05).(4)Empirical anti-infective therapy was performed on 34 patients with biliary tract infection,and the effective rate was 73.5%.Adjusted for the drug sensitivity of bile culture,the effective rate was 91.3%,and the result was not statistically different(P=0.3).Of the 7 patients with multidrug-resistant bacteria,4 had no empirical resistance to infection,and the bacteria culture expressed resistance to the antibiotic used empirically.Conclusion:(1)The types and quantity of pathogens in bile culture of patients with malignant obstructive jaundice after interventional therapy were mainly Gram-negative bacteria(71%).Gram-negative bacteria had the highest resistance rate to Ampicillin and Amoxicillin,and the highest sensitivity to Amikacin;The resistance rate of Gram-positive bacteria to Erythromycin and Penicillin was the highest,the sensitivity to Furantoin,Vancomycin,Tegacycline and high level of Gentamicin was the highest,and the resistance to other antibiotics was different degrees.Fungi are sensitive to common antifungal drugs.(2)The positive rate of bile culture in patients with malignant obstructive jaundice after interventional therapy was about 46%.Patients with ALT≥150U/L,postoperative biliary tract infection and interventional therapy ENBD and CA199≥270U/L were more likely to have positive bile culture.The incidence of biliary tract infection was 31% in patients with malignant obstructive jaundice after interventional therapy.Patients with obstruction duration >14 days,high obstruction and positive bile culture were more likely to develop biliary tract infection.(3)For patients with biliary tract infection after interventional therapy for malignant obstructive jaundice,the efficacy of empirical anti-infective therapy is limited,especially for patients with multi-drug resistant bacteria.