Guyot L, Allouch P, Legue E, Estenne B
Agressologie. 1989 Apr;30(4):177-82.
Without antibiotherapy, biliary surgery is often followed by infectious complications, possibly serious, indeed life-threatening. Biliary bacteria do are responsible of these complications; mainly E. Coli, Streptococcus faecalis (whose pathogenicity is disputed) and Klebsiella. Bacteroides fragilis and Pseudomonas aeruginosa are restricted to special circumstances. It is often difficult to presee whether bile is infected: some risk factors were emerged by Keighley but their specificity is not excellent; peroperative Gram staining got various results according to the studies. Some prefer to give a systematic antibiotherapy. Preoperative antibiotic treatment should be as short as possible because it does not sterilize bile, but selects resistant bacteria, which induce postoperative complications. It must mainly be aimed at preventing infectious scattering. Surgery is the main part of the treatment. Antibiotic choice has to take into account clinical picture, bacteria (those probably responsible for and their sensibility) and goal of the treatment (prophylactic or curative). Analysis of failures should allow to improve this choice. But only multicenter studies concerning full selected populations of patients are able to prove superiority of one antibiotic to another.
在没有抗生素治疗的情况下，胆道手术常常会引发感染性并发症，这些并发症可能很严重，甚至会危及生命。胆道细菌是这些并发症的罪魁祸首，主要是大肠杆菌、粪肠球菌（其致病性存在争议）和克雷伯菌。脆弱拟杆菌和铜绿假单胞菌仅限于特殊情况。通常很难预测胆汁是否被感染：Keighley发现了一些风险因素，但其特异性并不理想；根据研究，术中革兰氏染色结果各异。有些人倾向于进行系统性抗生素治疗。术前抗生素治疗应尽可能短，因为它不能对胆汁进行杀菌，反而会选择出耐药细菌，从而引发术后并发症。其主要目的必须是防止感染扩散。手术是治疗的主要部分。抗生素的选择必须考虑临床症状、细菌（可能致病的细菌及其敏感性）和治疗目标（预防性或治疗性）。对治疗失败案例的分析应有助于改进这种选择。但只有针对完全选定患者群体的多中心研究才能证明一种抗生素优于另一种抗生素。
