文献类型：期刊文献

中文题名：结石性胆囊炎胆汁厌氧菌感染特征与术后抗生素应用研究

英文题名：Anaerobic bacteriological profile in bile of calculous cholecystitis patients and its implications for postoperative antibiotic stewardship

作者：崔鸿斌[1,2];史树勋[3];马斌[1,2];李海元[1,2];韩晓雯[1,2];陈昊[1,2]

第一作者：崔鸿斌

机构：[1]兰州大学第二医院肿瘤外科,甘肃兰州730030;[2]兰州大学第二临床医学院,甘肃兰州730030;[3]甘肃中医药大学附属医院肛肠外科,甘肃兰州730000

第一机构：兰州大学第二医院肿瘤外科,甘肃兰州730030

年份：2026

卷号：52

期号：3

起止页码：44

中文期刊名：兰州大学学报(医学版)

外文期刊名：Journal of Lanzhou University(Medical Sciences)

基金：国家自然科学基金资助项目(82473266,82160129);甘肃省卫生健康行业科技创新重大科研资助项目(GSWSZD-2024-17);甘肃省联合科研基金一般项目(24JRRA929);甘肃省科技重大专项资助项目(22ZD6FA054);甘肃省重点人才资助项目(2019RCXM020);兰州市城关区科技计划资助项目(2020SHFZ0039);兰州大学第二医院“萃英科技创新”计划资助项目(CY2023-ZD-01)。

语种：中文

中文关键词：急慢性结石性胆囊炎;胆汁培养;病原菌;细菌分布;抗菌药物预防;厌氧菌;胆囊切除术

外文关键词：acute and chronic calculous cholecystitis;bile culture;pathogenic bacteria;bacterial distribution;antimicrobial prophylaxis;anaerobic bacteria;cholecystectomy

摘要：目的深入分析急慢性结石性胆囊炎患者胆汁中病原菌的感染特征,为临床抗生素的合理应用提供科学指导。方法选取2017年1月—2024年1月兰州大学第二医院收治的356例急慢性结石性胆囊炎患者作为研究对象。通过采集患者的胆汁样本,分别进行细菌厌氧培养和需氧培养,全面解析胆汁中病原菌的分布情况,并构建胆汁病原菌的构成谱系。结果在厌氧培养条件下,胆汁中病原菌的分布特征:无细菌生长者146例(41.0%),表皮葡萄球菌50例(14.0%),大肠埃希菌40例(11.2%),草绿色溶血性链球菌24例(6.7%),粪肠球菌20例(5.4%),人葡萄球菌20例(5.4%),屎肠球菌12例(3.6%),金黄色葡萄球菌12例(3.6%),微球菌10例(2.7%),肺炎克雷伯菌6例(1.7%),副流感嗜血杆菌4例(0.9%),阴沟肠杆菌4例(0.9%),溶血葡萄球菌4例(0.9%),沃氏葡萄球菌2例(0.6%),短小芽孢杆菌2例(0.6%),琼氏不动杆菌2例(0.6%),头状葡萄球菌2例(0.6%)。需氧培养条件下,病原菌的分布特征:无细菌生长者254例(71.3%),表皮葡萄球菌30例(8.4%),粪肠球菌18例(5.1%),大肠埃希菌16例(4.5%),人葡萄球菌16例(4.5%),头状葡萄球菌、金黄色葡萄球菌及阴沟肠杆菌各2例(各占0.6%)。不同胆囊炎类型间细菌分布差异无统计学意义(P>0.05)。细菌阳性患者胆囊结石直径更大(P=0.0016)、数量更多(P=0.003)、胆囊壁更厚(P<0.001)。结论在胆汁培养呈阳性的急慢性结石性胆囊炎患者中,厌氧菌占据主导地位。建议临床医师在腹腔镜胆囊切除术后,应谨慎考虑预防性抗生素的使用策略,避免不必要的抗生素治疗。
Objective To analyze the infection characteristics of pathogenic bacteria in the bile of patients with acute and chronic calculous cholecystitis,providing scientific guidance for rational antibiotic use.Methods A total of 356 patients with acute or chronic calculous cholecystitis undergoing laparoscopic cholecystectomy at The Second Hospital of Lanzhou University(January 2017-January 2024)were enrolled.Intraoperatively,bile samples were aseptically collected and subjected to parallel anaerobic and aerobic cultures to comprehensively analyze the distribution of pathogenic bacteria and establish a biliary pathogen profile.Results Anaerobic culture:no growth 146(41.0%);Staphylococcus epidermidis 50(14.0%);Escherichia coli 40(11.2%);Streptococcus viridans 24(6.7%);Enterococcus faecalis 20(5.4%);Staphylococcus hominis 20(5.4%);Enterococcus faecium 12(3.6%);Staphylococcus aureus 12(3.6%);Micrococcus spp.10(2.7%);Klebsiella pneumoniae 6(1.7%);Haemophilus parainfluenzae,Enterobacter cloacae,Staphylococcus haemolyticus 4 each(0.9%);Staphylococcus warneri,Bacillus pumilus,Acinetobacter junii,Staphylococcus capitis 2 each(0.6%).Aerobic culture no growth:254(71.3%);S.epidermidis 30(8.4%);E.faecalis 18(5.1%);E.coli 16(4.5%);S.hominis 16(4.5%);S.capitis,S.aureus,E.cloacae 2 each(0.6%).Bacterial distribution did not differ significantly between acute and chronic cholecystitis(P>0.05).Patients with bacteria-positive bile had a larger gallstone diameter(P=0.0016),greater stone number(P=0.003),and thicker gallbladder wall(P<0.001).Conclusion In patients with acute and chronic calculous cholecystitis with positive bile cultures,anaerobic bacteria predominate.It is therefore recommended that clinicians judiciously consider the strategy for prophylactic antibiotic use following laparoscopic cholecystectomy,avoiding unnecessary antimicrobial therapy to improve patient outcomes.