Research On Malignant Obstructive Jaundice Biliary Infection Status And Related Factors

Objective: Through the analysis of malignant obstructive jaundice(MOJ)combined biliary infection incidence,bile bacteria flora distribution and the sensitivity of the clinical commonly used antimicrobial agents,this paper aims to select MOJ combined biliary infection risk factors in order to guide the ERCP,PTCD clinical operation and provide reference for reasonable application of antimicrobial agents.Methods: By collecting clinical data of 106 patients with MOJ during ERCP or PTCD,with 63 male cases and 43 female cases aged 24 to 92(an average of 67).Among those cases,65 with high malignant obstructive jaundice and 41 with low malignant obstructive jaundice.the average serum total bilirubin is(200.80 + 23.7)umol/L,with a4-65 days jaundice.Through biopsy,the resection specimen pathological examination or imaging examination,a definitive diagnosis of those patients has been obtained and the statistics of MOJ tumor are as follows:of the 106 cases,58.5%(62/106)are bile duct carcinoma;17.0%(18/106)peroampullary tumors(pancreatic head carcinoma);9.4%(10/106)gallbladder;6.6%(7/106)hepatocellular carcinoma;5.7%(6/106)pancreatic cancer and 2.8%(3/106)stomach cancer,colon cancer,ovarian cancer and ovarian cancer abdominal lymph node metastasis.By intraoperative intubation into biliary for bile in ERCP and intraoperative by 7-8F outside puncture drainage tube into the biliary drainage in PTCD for bile,both take 5ml bile for inspection.Adopting the French merry Emmanuel VITEK microbe analysis system and software to conduct the bacteria identification and drug susceptibility test,we observed the distribution of pathogen flora obtained from the bile bacteria culture and compared it with the related high-risk factors of malignant tumor,and then analyzed the bacterial spectrum,the site of obstruction and other related factors.All MOJ patients underwent routine blood biochemical examination and blood coagulation function.We take their data into consideration,including age(over 60 years old,less than 60 years),gender(male and female),obstruction(high,low),treatment time(more than 14 days,less than 14 days),the primary tumor types(bile duct cell carcinoma,hepatocellular carcinoma,gallbladder cancer,pancreatic cancer,pancreatic cancer and other tumors),total bilirubin(more than100umol/L and less than 100umol/L)),C reactive protein(more than 10mg/L,and less than 10mg/L),prothrombin time(more than 12 s,and less than 12s),tumor marker CA199(more than 300U/L and less than 300U/L)and Whether there will be symptoms of biliary tract infection(white blood cells over 10 * 10 /L,arising in the course of upper abdominal pain and signs and symptoms of fever,the exclusion of the other system of acute infection).Through the comparision of count data with the chi-square test,we selected the relevant factors of statistical significance,and later we obtained the independent risk factors with the Logistic regression analysis.Results:(1)52 bile cultures are positive,a positive rate of 49%(52/106)and 19 kinds of pathogenic bacteria were isolated.The main biliary tract infection patho gens were Escherichia coli(32.7%),Klebsiella pneumoniae(9.6%),Enterobacter cl oacae(9.6%),Viridans streptococci(5.8%),Staphylococcus epidermidis(5.8%),Streptoc occus sanguis type I(5.8%),Enterococcus Faecium(3.9%),Hemolytic Streptococcus(3.9%)and Pseudomonas putida(3.9%).Fungus was Moniliaalbican(1.9%),and othe r rare species in 9 cases were Micrococcus luteus,Streptococcus mitis,streptococc us anginosus,S.paucimobilis,staphylococcus warneri,Staphylococcus cohnii,Staph ylococcus hominis,Streptococcus lugdunensis,Staph.saprophyticus,the detection rate was 1.9%.(2)Classifying those biliary tract infection pathogens with the gram staining,we detected 13 kinds of garm-positive bacteria in 22 strains,a proportion of 40.4%(21/52),and 5 kinds of gram-negative bacteria in 30 strains,a proportion of57.7%(30/52).Gram positive cocci of Vancomycin,Linezolid and Imipenem 100%sensitive.Gram-negative bacilli of Ertapenem,Imipenem,Sulbactam /Cefoperazone,Paediatric Compound Sulfamethoxazole Tablets,Gentamicin and amikacin 100%sensitive.The E.coli of ESBL positive rate was 70.6%(12/17),the klebsiella pneumoniae of ESBL positive rate was 40%(2/5).(3)Through the Chi-square analysis of the research factors,and taking P < 0.05 statistically significant,we found the Screened risking factors associated with biliary infection were as follows: age ≥60 years(X2 = 8.22 P <0.01),C-reactive protein ≥10mg/ L(X2 = 7.76 P <0.01),low biliary obstruction(X2 = 18.86 P < 0.01),combined biliary tract infection symptoms(X2 = 15.14 P <0.01).Later the multivariate Logistic regression analysis on risk factors related to the treatment showed that age,biliary obstruction and combined biliary tract infection symptoms are independent risk factors for the positive bile culture.Conclusions:(1)Malignant obstructive jaundice with biliary infection positive rate was49%.(2)The infection of Malignant obstructive jaundice patients with biliary tract is mainly caused by Gram-negative bacteria Escherichia coli,though the species of gram-positive bacteria outnumber the Gram-negative bacteria,Both types of bacteria were susceptible to imipenem.Due to the complexity of the clinical situation and the difficult treatment of malignant obstructive jaundice anti-infective,a lot of data research is to develop antimicrobial drug policy dealing with malignant obstructive jaundice with biliary tract infection.(2)Biliar Infection symptoms are more likely to be detected in the bileculture of aged patients with low biliary obstruction.Those above are independent risk factors for positive bile bacteria detection.