Analysis Of Bile Pathogen Detection In Patients With Malignant Obstructive Jaundice

Objective1. To survey the biliary pathogen and their drug sensitivity in patients with malignant obstructive jaundice, to explore the factors which related to the positive findings of bile culture in patients with malignant obstructive jaundice.2. To survey the pathogen in preoperative bile and postoperative peritoneal draining fluid and their drug sensitivity in patients with malignant obstructive jaundice, to explore the relationship between ERCP and positive pathogen findings in preoperative bile and postoperative peritoneal draining fluid.MethodsThe information of 65 patients with malignant obstructive jaundice admitted to surgery of Huashan Hospital from October 2007 to October 2008 were reviewed retrospectively. The factors which may potentially affect the detection of bile pathogen in patients with malignant obstructive jaundice were studied with univarite analysis and multivariate analysis, including:age, biliary surgery, yellow stained time, serum ALT level, SB level, CA19-9 level, tumor size, site of obstruction, with or without clinical manifestations of biliary infection, and APACHE II score.Patients with resectable pancreatic adenocarcinoma admitted to surgery of Huashan Hospital from October 2008 to December 2009 were divided into two groups: ERCP group and operation group(without ERCP) to explore ERCP's influence on bile pathogen as well as on postoperative intra-abdominal infection. Pathogen causing postoperative intra-abdominal infection in patients with pancreatic adenocarcinoma and their drug sensitivity were studied.Results25 positive cultures happened in 65 bile samples (38.5%), including 21 strains of Gram-negative bacilli (72.4%),6 strains of Gram-positive bacteria (20.7%), and 2 strains of fungi (6.9%). In Gram-negative bacteria, Escherichia coli and Klebsiella pneumoniae were common and were very sensitve to imipenem, meropenem and gentamicin. In Gram-positive cocci, enterococcus faecalis was common, which had no resistance to vancomycin, linezolid and teicoplanin. Univariate analysis showed that the relevant factors which may affect the rate of positive bile culture in patients with malignant obstructive jaundice were age, biliary surgery, biliary obstruction site, biliary tract infection symptoms and APACHEâ…¡score. Multivariate analysis showed that age, biliary surgery, biliary obstruction site and APACHEâ…¡score were independent risk factors.The rate of positive bile culture after ERCP was 66.7%, which was significantly higher compared with pre-ERCP (6.7%) and the operation group (7.1%)(p<0.05). In ERCP group, the rate of positive postoperative peritoneal draining fluid culture was 60%, but in operation group, the rate of positive postoperative peritoneal draining fluid culture was 25%, the difference was statistically significant (p<0.05). Abdominal pathogens after pancreatoduodenectomy in Gram-negative bacteria were mostly Acinetobacter baumannii, Escherichia coli and Pseudomonas aeruginosa, mainly showed multiple drug resistance, while Gram-positive cocci as Staphylococcus aureus and enterococcus faecalis, showed multiple drug resistance.Conclusion1. Age, biliary surgery, ERCP, biliary obstruction site and APACHEâ…¡score were independent risk factors which led to positive findings of bile cultures in patients with malignant obstructive jaundice.2. ERCP caused positive bile culture and may be potential risk factor of intra-abdominal infection after radical resection of pancreatic adenocarcinoma.3. Abdominal pathogens after radical resection of pancreatic adenocarcinoma were mainly Gram-negative bacteria. Gram-negative bacteria were mostly Acinetobacter baumannii, Escherichia coli and Pseudomonas aeruginosa, while Gram-positive cocci were Staphylococcus aureus and enterococcus faecalis.