Bacterial Spectrum Of Bile In Hepatolithiasis Patients And It's Relationship With The Infection After Operation

Objective: To analyze Bacterial spectrum of bile in patients with intrahepatic stone and analyze it's relationship with the infection after operation.And analyze the risk factor for infection after surgical treatment.Methods: 221 hepatolithiasis patients who had detailed bacterial culture data and underwent surgical treatment in first affiliated hospital of fujian medical university between January 2014 to December 2012 were retrospectively analyzed.All cases were documented in detail with patients' general situation,type of hepatolithiasis,surgical procedures,previous history of biliary surgery,whether concomitant diabetes,preoperative cholangitis,preoperative PTCD,operative time,hemorrhage during operation,drainage tube retention time,preoperative Wbc level,total bilirubin,serum albumin,transaminase levels,positive bile culture,the BMI,hepatic function total medical fees and admission day,etc.Analyzing the bacterial spectrum of bile in patients with intrahepatic stone.The incidence rate of infection(surgical site infection?intra-abdominal infection?biliary tract infection?bloodstream infection ? pneumonia)after surgical treatment.And analyze the relationship between the infection after surgical treatment with the bacterial spectrum of bile.According to whether they had infection,into infection group and non-infection group.And the risk factors related to postoperative infection complication were identified by Logistic regression.Results: In the 221 cases of bile culture,197 were positive with a positive rate of 89.14%.Twenty-seven kinds and 267 strains bacteria were identified,of which,158 were Gram-negative(59.18%),109 were Gram-positive(40.82%).The most three predominant bacteria flora were Escherichia Coli(79,29.59%),Enterococcus feacalis(53,19.85%),Klebsiella pneumoniae(35,13.11%).The drug susceptibility testing indicate that sensitivity of Gram-negative rods to amikacin,meropenem?cefepime?cefotetan?gentamycin,tobramycin?ceftazidime?ceftriaxone?was fairly good;On the contrary,the Gram-negative bacteria against Cefazolin,ampicillin,cefuroxime axetil were very high.The Sensitivity of Gram-positive bacteria to Tyrolide,gentamicin,moxifloxacin,levofloxacin,ciprofloxacin,ampicillin and penicillin G was fairly good.Otherwise,the Gram-positive bacteria against quinupristin/dalfopristin and erythromycin were very high.The univariate analysis showed that postoperative infection was associated with type of Hepatolithiasis,previous history of biliary surgery,concomitant diabetes,preoperative cholangitis,positive bile culture,hepatic function,operative time,hemorrhage during operation,nd drainage tube retention time,preoperative Wbc,total bilirubin,serum albumin,(all P<0.05);further multivariate analysis(Forward: LR)identiied that positive bile culture,oncomitant diabetes,operative time,preoperative serum albumin,and long drainage tube retention time were risk factors.The positive bile culture was associated with the biliary tract infection?the surgical site infection and the intra-abdominal infection,but it had no obvious relation with bloodstream infection?pneumonia after surgery.The bacterial spectrum of intraoperative bile in hepatolithiasis patients who had biliary tract infection?the surgical site infection or intra-abdominal infection after surgery was similar with their bacterial spectrum of postoperative bile or secreta.Conclusion: There are many kinds of bacterials hepatolithiasis patients' bile.The most predominant bacteria flora were Escherichia Coli,Enterococcus feacalis and Klebsiella pneumoniae.The bacterial spectrum of bile in hepatolithiasis patients has new changs.The cause of changes may be related to the increase types of antibiotics and the improper use of antibiotics.We should be strictly grasp the antibiotic use indications.According to the bacterial spectrum of bile in patients with intrahepatic stone,We suggest that the third or fourth generation cephalosporin drugs can be used as the preferred drug.AS to the infection caused b by Gram-positive bacteria,we do not support to use Mildew element drugs,if do not have a clear evidence.In addition,positive bile culture,oncomitant diabetes,operative time,preoperative serum albumin,and long drainage tube retention time were risk factors of postoperative infection ? The positive bile culture was associated with the biliary tract infection ? the surgical site infection and the intra-abdominal infection,but it had no obvious relation with bloodstream infection?pneumonia after surgery.The bacterial spectrum of intraoperative bile in hepatolithiasis patients who had biliary tract infection?the surgical site infection or intra-abdominal infection after surgery was similar with their bacterial spectrum of postoperative bile or secreta.