Abstract:

Objective To investigate the colonization of multidrug resistant organisms （MDROs） and the impact of antibiotic therapies on MDROs colonization in patients with cholangitis after Kasai procedure，and to provide scientific evidence for clinical prevention and control measures. Methods Cases with cholangitis after Kasai surgery from January 2021 to June 2022 in Tianjin First Central Hospital were retrospectively collected. The children were divided into case group （colonized） and control group （non-colonized） according to their MDROs colonization status when admitted to pediatric department， and the general conditions， Kasai procedure time， biliary atresia classification， previous cholangitis times and previous use of antibiotics were compared between the two groups. Results A total number of 76 strains of pathogenic bacteria were detected in rectal swabs of 64 children， including 43in the MDROs group and 21 in the non-MDROS group.Klebsiella pneumoniae was the most common bacterium （37 cases，33cases were carbapenemresistant）， followed by Enterococcus faecium（12 cases，1 case was vancomycin resistant） and Escherichia coli（11 cases，4 cases were carbapenem-resistant）. There were no significant differences in general conditions， Kasai operation time， biliary atresia classification， and previous cholangitis times between the two groups. The rate of therapy with carbapenems in MDROs group was higher than that in non-MDROS group （53.5% vs. 33.3%，P ＝ 0.129）. The rate of therapy with broadspectrum antibiotics in MDROs group was higher than that in non-MDROS group （39.5%vs. 19.0%，P ＝ 0.101）. The rate of therapy with more than two antibiotics in MDROs ，group was higher than that in non-MDROS group （51.2% vs. 19.0%，P＝0.014）. ConclusionCombination antimicrobial therapy with two or more drugs may lead to colonization of MDROsresulting in bloodstream infection and biliary tract infection of MDROs due to intestinal bacterial translocation. Therefore，effective prevention and treatment measures should be taken to reduce the incidence of MDROs in children after Kasai. 

Key words:

Kasai； , Cholangitis； , Multidrug-resistant organism colonization； , Colonization

摘要：

目的 分析 Kasai 术后患儿肠道定植菌的耐药情况及抗菌药物使用对多重耐药菌（multidrug resistant organisms，MDROs）定植的影响，以期为Kasai 术后胆管炎患儿MDROs定植的预防和治疗提供参考依据。方法收集 2021 年 1 月至2022 年 6 月天津市第一中心医院收治的Kasai术后胆管炎病例，根据患儿入院时的 MDROs 定植情况将患儿分为病例组（定植）和对照组（无定植），比较两组患儿的一般情况、Kasai 术时日龄、胆道闭锁分型、既往胆管炎次数与既往静脉抗菌药物使用情况。结果 共纳入 64 例患儿，MDROs 组 43 例，非 MDROs 组 21 例。从直肠拭子中检出致病菌 76 株，肺炎克雷伯杆菌最多（37 例，耐碳青霉烯类33 例），其次为屎肠球菌（12 例，耐万古霉素 1 例）、大肠埃希菌（11 例，耐碳青霉烯类 4 例）。两组患儿一般情况、Kasai 术时日龄、胆道闭锁分型、既往胆管炎次数无统计学差异 ；MDROs 组碳青霉烯类抗菌药物使用率高于非 MDROs 组，分别为 53.5% 和33.3%（P ＝ 0.129），MDROs 组广谱抗菌药物使用率高于非MDROs 组， 分别为 39.5% 和 19.0%（P ＝ 0.101），MDROs 组 2 种以上抗菌药物联合静脉应用率高于非MDROs 组，分别为51.2% 和 19.0%（P ＝ 0.014）。结论 两种以上抗菌药物联合应用可能会导致 MDROs 的定植，从而因肠道细菌移位引起 MDROs 的血流感染和胆道感染。因此应采取有效防治措施，合理应用抗菌药物，减少 Kasai 术后患儿 MDROs 的发生。

关键词:

Kasai , 胆管炎 , 多重耐药菌 , 定植