肝内胆管结石合并胆道感染的细菌谱

Distribution characteristics of biliary bacteria and postoperative care in patients with cholelithiasis

AIM: To analyze the distribution of biliary bacteria and postoperative care in patients with cholelithiasis and to explore the relationship between the Gram-positive (G⁺) bacteria, Gram-negative (G^-) bacteria and postoperative care.

METHODS: Ninety-six patients with gallstones and infection were divided into either a G⁺ group (n = 16) or a G^- group (n = 80) according to the results of bile culture. The culture results of pathogenic bacteria in bile samples were analyzed, and the epidemiological distribution, infection, incision healing, T tube removal time, number of sterile dressing changes, and suture removal time were compared between the two groups.

RESULTS: In 96 bile samples, 16 (16.67%) G⁺ strains were isolated, including 15 Enterococcus strains and 1 Staphylococcus strain; 80 (83.33%) G^- strains were isolated, including 51 Escherichia coli strains, 13 Klebsiella pneumoniae strains, 6 Pseudomonas aeruginosa strains, 4 Enterobacter cloacae strains, and 6 other strains. There were no significant differences in the rates of infection and incision healing (6.25% vs 20.00%, 93.75% vs 80.00%, 18.75% vs 11.25%, 62.50% vs 67.50%, 12.50% vs 1.25%, 0.00% vs 15.00%, 0.00% vs 3.75%, 6.25% vs 0.00%, 0.00% vs 1.25%, P > 0.05) between the two groups. The time to T tube removal, the number of sterile dressing changes, and the time to suture removal were significantly lower in the G⁺ group than in the G^- group (16.81 d ± 2.69 d vs 23.52 d ± 10.01 d, 8.42 ± 4.29 vs 14.71 ± 11.70, 9.24 d ± 1.48 d vs 13.54 d ± 6.62 d, P < 0.05).

CONCLUSION: The main pathogens in patients with cholelithiasis and biliary tract infection are G^- bacteria, with E. coli being the most common. The postoperative care of T tube and operative incision should be enhanced in patients with G^- bacterial infection to promote wound healing and reduce the number of dressing changes and patient care costs.