Multivariate analysis of clinical and operative findings associated with biliary sepsis

Abstract

A cluster analysis of 17 preoperative and 10 operative variables has been undertaken from a prospective study of 181 patients undergoing operations on the biliary tract in order to identify those with organisms in the bile who would therefore benefit from prophylactic antibiotic cover. The analysis defined populations of high risk (45 patients) and low risk (136 patients) in which the incidence of infected bile was 67 and 19 per cent respectively (P less than 0-001). Eight variables were more common in the high risk than in the low risk group (P less than 0-001). These "high risk factors" were: jaundice at operation, recent rigoors, emergency operation or one within 4 weeks of an emergency admission, age over 70 years, previous biliary operation, common duct obstruction and stones in the bile duct. In 67 patients where one or more "high risk factors" was present, the bile contained organisms in 37 (53 percent); when 4 "high risk factors" occurred in the same patient (16 cases) biliary organisms were isolated in 14(87 per cent). We conclude that the presence of one or more "high risk factors" indicates a patient in whom prophylactic antibiotics would be advised during an operation on the biliary tract.

Effects of plastic stenting in commom bile duct of rats: a quantitative reaction analysis using collagen and elastin morphometry

“…Retrospective study has shown that patients with bacteria in the bile are epidemiologically similar to the patients with high risk for postop infections (15 to 20%) 7 . Although, the incidence of bacteria in the bile of the patients with jaundice due to pancreatic head Ca varies from 16 to 25% without endoscopic drainage and 1-3% with drainage by plastic biliary stent 2,7,8 . With this, can understand that the inflammatory thickening of the bile duct wall due to the infection represent one of the most important factors in postop complications of patients who underwent prior endoscopic drainage.…”

“…There are evidences indicating relationship between bile with bacteria and the frequency of postop complications 7,8 . Retrospective study has shown that patients with bacteria in the bile are epidemiologically similar to the patients with high risk for postop infections (15 to 20%) 7 .…”

Routine or Selective Antibiotic Prophylaxis in Biliary Surgery

“…Some of these factors were studied in detail by other workers. 13,14 All patients admitted with cholangitis or who had a recent history of cholangitis gave positive bile cultures, while the bile was positive for culture in 88% of the patients admitted with jaundice alone.…”

Urease Positive and Slime Producing Bacterial Activity: Results in Gallstone Precipitation and Solidification

“…So far, the most common bacteria isolated from gallstones are aerobes (3,4), which include E. coli (5)(6)(7), Klebsiella spp. (6,7), Enterobacter fecalis (8,9), Streptococcus spp., Pseudomonas spp. (4,8,9) and Salmonella (10).…”