Bacterial Culture And Drug Sensitivity Analysis Of Drainage Fluid Postoperative Hepatolithiasis

Objective:To understand the distribution of pathogens in the drainage fluid of patients with intrahepatic and extrahepatic cholelithiasis after operation,the sensitivity of pathogens to antibiotics and the risk factors of the positive culture of drainage fluid,as well as to use antibiotics more pertinently and to provide corresponding treatment measures for the relevant factors,and to reduce the incidence of postoperative infection and improve the prognosis.Methods:From January 2019 to December 2019,the clinical data of consecutive 71 patients with hepatolithiasis in one treatment were collected.After the operation,the drainage fluid was collected through T tube and/or drainage tube for bacterial culture and drug sensitivity test,and the bacterial distribution of drainage fluid in patients with hepatolithiasis in our hospital was analyzed,as well as the antibiotic drug sensitivity test.According to the source of the drainage fluid,it was divided into two groups: bile group and abdominal drainage fluid group.The differences of pathogenic bacteria between the two groups were analyzed.Results:(1)The positive rate of pathogenic bacteria culture was 80.3%,in which 15 cases were mixed infection,accounting for 26.3% of the infected patients.83 strains were cultured,including 47 gram-negative bacilli(47/83,56.6%),35 Gram-positive bacilli(35/83,42.2%),1 fungus(1/84,1.2%),21 Escherichia coli(25.3%),17 Enterococcus faecalis(20.5%),11 Klebsiella pneumoniae(13.3%),8 Pseudomonas aeruginosa(9.6%),and cloaca Four Enterobacteriaceae strains(4.8%).the highest isolation rate of Gram-negative bacteria was Escherichia coli,while Enterococcus faecalis was the main Gram-positive bacteria.(2)The results showed that the sensitivity of Gram-negative bacteria to tegacyclin was 91.4%,amikacin 82.6%,meropenem 82.2%,imipenem 80.4%.The highest resistance rate to cefazolin was80%,followed by ampicillin and ceftriaxone >60%.The highest sensitivity of Gram-positive bacteria to daptomycin was 100%,followed by 94.3% of linezolid III,84.4% of ampicillin and 82.4% of vancomycin.(3)In this study,15 ESBLs producing strains were found,the detection rate was 18.1%.10 strains of E.coli and 5 strains of Klebsiella pneumoniae accounted for 47.6% and 45.5% respectively.(4)Some strains were naturally resistant to some antibiotics,such as: Enterococcus of hens Stenotrophomonas maltophilia(5)The strains cultured from peritoneal drainage fluid were similar to those from bile,but the number of the strains was different;6 of 18 patients without symptoms of biliary tract infection had positive bile culture(6)the correlation analysis showed that: before operation ALP ?202.5u/l,?-glutamyltransferase ?300u/L,biliary tract infection,previous history of biliary tract operation,calculus in the liver and operation time ?3H had significant correlation with the positive of drainage medium culture(P < 0.05).Conclusion:(1)The bacteria isolated from the drainage fluid of patients with hepatolithiasis in our hospital were mainly Gram-negative bacteria,sequentially Escherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa,while the Gram-positive bacteria were Enterococcus faecalis,Enterococcus faecium and Enterococcus casei /hen.The main pathogens were Escherichia coli and Enterococcus,the proportion of Enterococcus was higher than that reported formerly,and the positive rate of ESBLs in Escherichia coli and Klebsiella pneumoniae should the same trend.(2)The bacteria cultured in the drainage fluid had a high resistance rate to common antibiotics,and the drug sensitivity spectrum changed to some extent.In clinical practice,it was necessary to strengthen the detection of pathogenic bacteria and drug sensitivity.The antimicrobial agents were selected reasonably according to the etiological results.(3)For the patients with intrahepatic and extrahepatic bile duct stones,the positive results of drainage culture were not always indicate the biliary tract infection,but it would still be a risk factor for postoperative infection.(4)The results of bacterial culture in the peritoneal drainage fluid were similar to those of bile pathogens.(5)serum levels of alkaline phosphatase ? 202.5u/l,serum levels of ?-glutamyltransferase ? 300 u / L,symptoms of biliary tract infection,previous historyof biliary tract operations,intrahepatic lithiasis and operation time ? 3h,might result in the high positive rate of bacterial culture in drainage fluid.