Etiology Analysis And Clinical Significance Of Biliary Tract Infection Of Biliary Disease Patients

Background:Benign and malignant biliary tract diseases are a kind of common digestive disease,which incidence is increased gradually.In some cases,it is easy to be complicated with biliary tract infection.The composition of the bacterial spectrum of biliary tract infection may be different because of the type of disease,the regional distribution,and the time migration.However,there is a relative lack of relevant researches in this field,especially in large samples.Aims:To investigate the bacteriological characteristics and drug sensitivity of biliary tract infection in patients with benign and malignant biliary diseases,and to provide evidence for clinical experience therapy of biliary tract infection.Methods:This retrospective study analyzed 1339 bile samples of benign and malignant biliary diseases from August 2008 to April 2017 in the Second Affiliated Hospital of Nanjing Medical University.The bacterial identification and preliminary drug sensitivity test of bile samples were carried out by Vitek 2 automatic microbiological identification system.The clinical data of the patients were collected for comparative analysis,and the data were analyzed by SPSS software.Results:(1)Results of pathogenic bacteria: 738 of 1339 bile samples were positive,the positive rate was 55.12%.Of which 652 were single bacterial infection and 86 were mixed infection.A total of 826 strains of bacteria were identified.There were 619 strains of gram-negative bacteria,189 strains of gram-positive bacteria,and 18 strains of fungi.In addition,the most common gram-negative bacteria were Escherichia coli(312,37.78%),Klebsiella pneumoniae(85,10.29%)and Pseudomonas aeruginosa(74,8.96%).The most common gram-positive bacteria were Enterococcus faecium(51),Enterococcus faecium(32)and Enterococcus faecalis(21)respectively.The most common fungi were Candida albicans(14),Candida tropicalis(3)and Candida albicans(1).In this study,we also analyzed the changes of the proportion of pathogenic bacteria infection in the three groups,the percentage of gram-positive bacteria was higher.(2)Drug sensitivity results:Overall,for isolated gram-negative bacteria,The resistance of triamcinolone and ampicillin was high(80.45%,88.78%),and were high sensitivity to piperacillin / tazobactam and carbapenems(88.14%,100%).For isolated gram-positive bacteria,such as Enterococcus faecium,the resistance of ampicillin was 72.55%,the resistance of quinolone was 66.67%.The resistance rate of gentamicin and piperacillin / tazobactam was 35.29% and 54.90% respectively.Only vancomycin and other narrow spectrum antibiotics were sensitive to them(100%).(3)The distribution of bacteria in bile samples of benign and malignant biliary disease: The common bacteria in patients with benign biliary diseases were Escherichia coli(231,41.7%),Pseudomonas aeruginosa(85,10.29%),Klebsiella pneumoniae(55,9.93%)and Enterococcus faecium(39,7.04%).In addition,the common bacteria in the patients with malignant biliary diseases were Escherichia coli(81,44.02%),Klebsiella pneumoniae(30,16.30%),Pseudomonas aeruginosa(19,10.33%)and Enterococcus faecium(12,6.52%).The content of Klebsiella pneumoniae was significantly different between the two groups(55 vs 30;P = 0.019).(4)Factors influencing the positive rate of bile culture: The positive rate of bile culture was significantly higher in the group of age >= 60 years old,the group of fever,the history of biliary diseases and surgery,the group of benign biliary tract diseases and the group of patients with chronic renal insufficiency and the group of patients with chronic renal insufficiency than jaundice group,abdominal pain group,no biliary disease and biliary tract operation history group,malignant diseases group,hypertension group,diabetes group,cerebral infarction group,coronary heart disease group,chronic bronchitis group(P < 0.05).Conclusion:(1)The bacterial infection rate of benign and malignant biliary tract diseases was high,and gram-negative bacteria was still the main bacteria,but they were highly resistant to ceftriaxone and ampicillin.Gram-positive bacteria were highly resistant to ampicillin and quinolones and were sensitive to vancomycin.(2)Klebsiella pneumoniae was different in benign and malignant biliary diseases,and the infection rate was relatively high in malignant biliary diseases.(3)The elderly patients,with fever symptoms,with history of biliary diseases and biliary tract surgery,the benign biliary diseases and combining with chronic renal insufficiency were the related factor of high positive rate of bile culture.