目的 對比肝膽惡性腫瘤患者膽道混合菌感染與單一菌感染對患者造成的損失的差異。方法 選取天津醫(yī)科大學腫瘤醫(yī)院2017年1月—2019年12月診斷為肝膽惡性腫瘤且發(fā)生膽道感染的患者，按膽汁培養(yǎng)病原菌種數(shù)分為混合菌感染組和單一菌感染組，收集病例相關信息，采用傾向性得分匹配法（PSM）對兩組患者進行1∶1配對，配對成功后，采用配對樣本秩和檢驗和配對樣本t檢驗的方法對兩組患者的住院天數(shù)、住院費用、用抗菌藥天數(shù)、抗菌藥費用、抗菌藥用藥頻度（DDDs）進行分析。結果 最終匹配成功32對，混合菌感染組患者住院天數(shù)中位數(shù)為25.00 d；單一菌感染組患者住院天數(shù)中位數(shù)為14.50 d，兩組具有顯著性差異（P<0.05）；混合菌感染組患者住院總費用中位數(shù)為46 779.78元；單一菌感染組患者住院總費用中位數(shù)為35 512.73元，兩組具有顯著性差異（P<0.05）；混合菌感染組患者用抗菌藥天數(shù)中位數(shù)為13.00 d；單一菌感染組患者用抗菌藥天數(shù)中位數(shù)為11.00 d，兩組具有顯著性差異（P<0.05）；混合菌感染組患者抗菌藥費用中位數(shù)為5 396.91元；單一菌感染組患者抗菌藥費用中位數(shù)為3 200.94元，兩組具有顯著性差異（P<0.05）；混合菌感染組抗菌藥DDDs為62.38±36.63，單一菌感染組抗菌藥DDDs為49.78±17.86，兩組具有顯著性差異（P<0.05）。結論 肝膽惡性腫瘤膽道混合菌感染導致患者住院時間、抗菌藥應用時間延長，住院費用、抗菌藥費增加、抗菌藥DDDs增加，因此，降低混合菌感染率至關重要。

Objective To compare the difference of patients losses caused by mixed bacterial infection and single bacterial infection in patients with hepatobiliary malignancies.Methods Patients diagnosed with hepatobiliary malignant tumor and biliary tract infection in Cancer Hospital of Tianjin Medical University from January 2017 to December 2019 were selected and divided into mixed bacteria infection group and single bacteria infection group according to the number of pathogenic bacteria in bile culture. The relevant information of cases was collected, and the PSM propensity score matching method was used for 1∶1 matching between the two groups. After successful matching, the paired sample rank sum test and paired sample t test were used to analyz the length of stay, hospitalization expenses, days of using antibiotics, cost of antibiotics and DDDs were analyzed.Results The final match was successful in 32 pairs, the median length of stay in the mixed bacteria infection group was 25.00 days; the median hospitalization days in the single bacteria infection group was 14.50 days, with significant difference between the two groups (P<0.05); the median hospitalization expenses of the mixed bacteria infection group was 46 779.78 yuan; the median hospitalization expenses of the single bacteria infection group was 35 512.73 yuan, which was significant between the two groups. The difference was statistically significant (P<0.05); the median days of using antibiotics in mixed bacteria infection group was 13.00 days, the median days of single bacteria infection group was 11.00 days, with significant difference between the two groups (P<0.05), the median cost of antibiotics in mixed bacteria infection group was 5 396.91 yuan, the median cost of antibiotics in single bacteria infection group was 3 200.94 yuan, with significant difference between the two groups. The difference was statistically significant (P<0.05), the DDDs of mixed bacteria infection group was 62.38 ±36.63, and that of single bacteria infection group was 49.78 ±17.86, with significant difference between the two groups (P<0.05).Conclusion The infection of mixed bacteria in biliary tract of patients with hepatobiliary malignant tumor leads to the prolongation of hospitalization time, the application time of antibiotics, the increase of hospitalization expenses, the increase of antibiotics expenses, and the increase of DDDs of antibiotics. Therefore, it is very important to reduce the infection rate of mixed bacteria.

R979.1

國家自然科學基金資助項目（81703454）