Chen M F, Jan Y Y
Department of Surgery, Chang Gung Memorial Hospital, Chang Gung College of Medicine and Technology, Taipei, Taiwan.
Hepatogastroenterology. 1996 May-Jun;43(9):586-9.
BACKGROUND/AIMS: The following investigation was undertaken in order to determine the frequency and clinical consequences of bacteremia after postoperative choledochofiberscopy.
A total of 100 patients were prospectively studied for the frequencies of bacteremia after postoperative choledochoscopy.
Positive blood cultures were obtained in 15%; at 5-minutes period in seven patients, at 15-minutes in eight patients and at 30-minutes in two patients. There were two patients with positive cultures at 5 minutes and 10 minutes periods. All the bacteria species cultured were aerobes. Enterococcus, E-coli and Klebsilla were the most commonly cultured bacteria. The frequencies of occurrence of bacteremia seemed not be influenced by the existence of residual stones, session of the endoscopy and duration of the procedure. Six of the 15 bacteremic patients developed cholangitis within 24 hours of the procedure. They all recovered with antibiotic treatment. Patients with negative blood cultures were not found with cholangitic symptoms after the postoperative choledochoscopy.
The results of our study indicated that fifteen percent of patients undergoing postoperative choledochofiberscopy are associated with bacteremia. We believe that with adequate aseptic preparation and meticulous, gentle manipulation, routine prophylactic antibiotics may not be necessary for postoperative choledochoscopy in selected conditions.
背景/目的：进行以下调查以确定术后胆管纤维内镜检查后菌血症的发生率及临床后果。
前瞻性研究了100例患者术后胆管镜检查后菌血症的发生率。
血培养阳性率为15%；7例患者在5分钟时血培养阳性，8例在15分钟时阳性，2例在30分钟时阳性。有2例患者在5分钟和10分钟时血培养均为阳性。所有培养出的细菌均为需氧菌。肠球菌、大肠杆菌和克雷伯菌是最常培养出的细菌。菌血症的发生率似乎不受残余结石的存在、内镜检查次数和操作持续时间的影响。15例菌血症患者中有6例在术后24小时内发生胆管炎。经抗生素治疗后均康复。术后胆管镜检查后，血培养阴性的患者未出现胆管炎症状。
我们的研究结果表明，15%的接受术后胆管纤维内镜检查的患者会发生菌血症。我们认为，在有充分的无菌准备以及细致、轻柔的操作下，在某些特定情况下，术后胆管镜检查可能无需常规预防性使用抗生素。
