Cueto-Ramos Rubén, Hernández-Guedea Marco, Pérez-Rodríguez Edelmiro, Reyna-Sepúlveda Francisco, Muñoz-Maldonado Gerardo
Servicio de Cirugía General, Hospital Universitario «Dr. José Eleuterio González», Monterrey, México.
Servicio de Cirugía General, Hospital Universitario «Dr. José Eleuterio González», Monterrey, México.
Cir Cir. 2017 Nov-Dec;85(6):515-521. doi: 10.1016/j.circir.2016.10.030. Epub 2017 Jan 16.
Through experience it has been accepted that bile in normal conditions remains sterile. Bactibilia is a common finding in individuals at high risk or with complicated cholecystolithiasis, however few data prevails about the prevalence of bactibilia in patients operated on for uncomplicated laparoscopic cholecystectomy. There is s common usage of preoperative and postoperative antibiotics in the different patients without the existence of any actual bacteriologic and epidemiologic evidence.
183 patients with diagnosis of cholecystolithiasis postoperated of laparoscopic cholecystectomy had their bile sent to bacteriology.
Bactibilia was identified in 31.95% of the cultures of mild cholecystitis and in 35.71% for moderate (p<.0001). A total of 125 negative cultures were obtained (68.3) and 58 positive (31.69%) with a prevalence of enterobacteria group (43.10%) and Enterococcus (27.58).
Comparing the groups according to severity there is a significant difference with regard to the presence of bactibilia, in addition to the bacterial groups cultivated. Fluoroquinolones and metronidazole is an option for the treatment of patients with the suspicion of bactibilia. The use of antibiotics is not justified in patients at low risk.
根据经验,人们普遍认为在正常情况下胆汁是无菌的。胆系感染在高危个体或合并复杂胆囊结石病患者中很常见,然而,关于单纯性腹腔镜胆囊切除术患者胆系感染患病率的数据却很少。在没有任何实际细菌学和流行病学证据的情况下,不同患者普遍在术前和术后使用抗生素。
183例诊断为胆囊结石并接受腹腔镜胆囊切除术的患者的胆汁被送去做细菌学检查。
轻度胆囊炎患者胆汁培养中31.95%发现有细菌,中度胆囊炎患者胆汁培养中35.71%发现有细菌(p<0.0001)。共获得125份阴性培养结果(68.3%)和58份阳性培养结果(31.69%),其中肠杆菌属(43.10%)和肠球菌属(27.58%)最为常见。
根据严重程度对各组进行比较,胆系感染的存在以及培养出的细菌种类均存在显著差异。氟喹诺酮类和甲硝唑可作为疑似胆系感染患者的治疗选择。低风险患者使用抗生素并无依据。