| ERCP(after ERCP Encoscopic Retrograde Cholangio Pancreatography,ERCP)bloodstream infections occurred after ERCP is the more common complications,because of the bile duct obstruction and bacterial infection in bile duct,the marked increase in internal pressure in patients with liver bile blood barrier severely damaged,bacteria and toxins into the blood circulation in the patients,eventually to courage system disease loss is relatively rare,is a kind of often severe infectious disease complicated with multiple organ damage.Biliary tract infection as a digestive internal medicine is one of the most common symptoms and liver and gallbladder surgery,a common cause of biliary infection to invade the biliary bacteria multiply and cause of biliary severe inflammation.Biliary tract infection is given priority to with G-bacillus and the most common bacteria is the G + cocci infection,the third to fungal infection.Studies have found that bile culture positive bile,about 40.82% of patients with combined anaerobic bacteria infection.Often and differences and cultivation,separation methods,related technology.Large doses of antibiotics application again after bile culture also often appear no bacterial growth.Bacteria in bile source mainly includes the uplink infection,the most common intestinal bacteria through duodenum into the biliary tract.Its pathophysiological mechanism of biliary obstruction is aggravating,biliary internal pressure increased significantly,as bacteria and toxins through the blood capillary and lymphatic,into a lot of the circulation of the blood which occurred severe sepsis,cause infection in patients with toxic shock that multiple organ failure,and so on and so forth.Choose reasonable antibiotics in the clinical work is one of the most important aspects of the treatment of biliary tract infection,especially for difficult to obtain bile specimens or early clinical treatment of patients with gallstone infection and bacterial culture and drug susceptibility results is particularly important when hasn't come out.Treatment mainly for the theoretical basis of the previous clinical on biliary tract infection in patients with bacterial culture and drug susceptibility results,while on the collected blood samples of ERCP in patients with postoperative bloodstream infections,bacterial culture and drug susceptibility results of statistical analysis,biliary tract infection pathogens distribution and drug resistance of genotyping research I area,there is no relevant research,so the region recently various culture specimens and drug susceptibility results are detailed analysis,statistical analysis,from the choose for clinical antibiotic treatment as a guide to assist the clinical experience administration is of great importance,to strengthen the management of postoperative infection in patients with ERCP,improve patients' recovery rate and survival rate.Objective:1 The survey ERCP hospitalized patients with postoperative infection rate,evaluate the risk factors of postoperative bloodstream infections.2 Analysis of ERCP bloodstream infections in patients with postoperative main etiology distribution of past data for comparison.3 The study of ERCP bloodstream infections in patients with postoperative common bacteria resistant genotypes,to facilitate clinical choose suitable antibiotics,assist and guide clinical experience administration anti-infection drugs.Methods:1 The application and the second affiliated hospital of hebei medical university,a total of 410 patients with ERCP,analysis of patients' general information,assay and auxiliary examination data,using single factor analysis and multi-factor logistic logistic regression analysis method to study the risk factors for postoperative patients with bloodstream infections.2 Blood bacterial culture and identification,drug sensitive test according to the third edition of the national clinical laboratory medicine procedures,identification of reagent to use biological merry Emmanuel France bacteria numerical classification identification system(apis)and VITEK2-Compact detecting instrument,drug sensitive test with Shanghai hundred no minimum inhibitory concentration(MIC)method and paper susceptibility diffusion method(K-B method),the M-H AGAR and drug susceptibility paper OXOID company bought both from Britain.Automatic microorganism cultivation and identification technology is applied to analyze the 125 strains of isolated bacteria were collected for analysis of the distribution and drug susceptibility of past compare dynamic data collected.3 At the same time,the main pathogenic bacteria in bacteraemia by polymerase chain reaction(PCR)test related resistance genes,the main resistance mechanism are discussed.Results:1 This study through the measures above statistics found postoperatively in patients with ERCP bloodstream infection rate is about 29%,of which the single factor analysis of low serum albumin leels,older age,preoperative jaundice time,preoperative biliary infection and average daily traffic guide are prone to postoperatively in patients with risk factors of biliary tract infection,and the evil nature of biliary obstruction and the diseases parts are independent risk factors of ERCP in biliary postoperative infection.2 Infection in patients with a total of 119 people,a total of produce 125 strains pathogenic bacteria were isolated from 120 strains of aerobe,120 strains ZhongGe bacterium of negative of orchid 79 strains,65.83%;41 strains gram-positive bacteria,accounting for 34.16%,main pathogenic bacteria including gram-negative bacteria pseudomonas aeruginosa,klebsiella pneumoniae,white fungus,enterococcus,and e.coli.Gram negative bacteria to the carbon blue enzyme alkenes medicine,cefoperazone/shu,and more sensitive to amikacin,resistance to less than 1.4%,10.6% and 3.43%,respectively.3 Continuous collected 53 strains of e.coli,a total of 46 strains of bacteria to produce ultra broad spectrum ? lactamase;Are CTX-M type ultra broad spectrum ? lactamase,CTX-M-1 group of 26 strains,CTX-M-9 group of 16 strains,including four strains of bacteria to produce two groups of CTX-M type,sequence alignment,a total of 6 kinds of genotype.And enzyme production of e.coli bloodstream infection group compared to produce ultra broad spectrum ? lactamase group of high level of use of antibiotics,number,and nosocomial infection rate is high,the patient also has a high mortality rate.Conclusion:1 This study suggests found that low serum albumin leels,older age,preoperative jaundice time,preoperative biliary infection and average daily traffic guide are prone to postoperatively in patients with risk factors of biliary tract infection,and good evil nature and ERCP in biliary postoperative biliary obstruction parts are independent risk factors of infection,high-risk patients should pay attention to take measures to prevent the occurrence of biliary tract infection.2 After ERCP bloodstream infections bacteria is still mainly gram-negative bacteria,and when the gram-positive bacterium of pathogenic bacteria,pay attention to choose narrow-spectrum antibiotics according to the results of the blood culture.3 ERCP in patients with postoperative blood infected with e.coli to produce ultra broad spectrum P lactamase main genotype for CTX-M type;Pay attention to the reasonable choose effective antibiotics and pay attention to the infection control development in a timely manner. |
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