Abstract
A unifactorial analysis for possible risk factors was applied to 2,700 consecutive operations for benign disease of the biliary tract. A series of high risk factors in relation to positive bacteriology and septic complication could be identified. These risk factors were patients who were elderly (>70 years;p<0.001), those who were diabetic, those who had a serum bilirubin >1.1 mg% (p<0.001), those who had acute cholecystitis (p<0.001), and those in whom choledochal stones were found (p<0.001). Using a multivariate analysis, we concluded that in patients with no risk factors (56.9%) the incidence of a positive bacteriology was low (10.9%) and they should receive no antibiotic prophylaxis. Patients with one risk factor (24%), had a 36% incidence of positive bacteriology and minimal pre-operative prophylaxis is recommended. Patients with two or more risk factors (19.1%) had a 77.6% incidence of positive bacteriology and full peri-operative prophylaxis is recommended, starting pre-operatively and continuing for 3 to 5 days postoperatively. The aim of this study was to identify patients at risk for septic complication in biliary surgery and to create new guidelines for the antibiotic treatment of selected groups.
Résumé
Par une analyse multifactorielle réalisée chez 2700 patients consécutifs ayant une maladie, bénigne des voies biliaries, on a cherché à déterminer les possibles facteurs de gravité. On a ainsi identifié une série de facteurs associés des prélèvements bactériologiques positifs et des complications septiques: patients âgés de plus de 70 ans (p<0.001), diabétiques, patients ayant une bilirubinémie >1.1 mg% (p<0.001) et ayant une lithiase de la voie biliare principale (p<0.001). En analyse multifactorielle, nous avons conclu que chez les patients n'ayant aucun facteur de risque (56.9% de la série), l'incidence de prélèvements bactériologiques positifs était basse (10.9%) et qu'il n'était donc pas nécessaire de donner une antibioprophylaxie. Chez les patients ayant un facteur de risque (24% de la série), l'incidence de bactériologie positive était de 36%, et un minimum d'antibioporphylaxie était conseillé. Chez les patients ayant deux facteurs de risque ou plus, (19.1% des la série), l'incidence de bactériologie positive était de 77.6%, et une antibiothérapie périopératoire était conseillée, en commençant avant l'opération et en continuant trois à cinq jours après. Le but de cette étude a été d'identifier les patients à risque de complications septiques dans la chirurgie biliarie afin d'ériger de nouvelles règles de traitement antibiotique.
Resumen
Un análisis unifactorial para riesgos potenciales fue aplicado a 2.700 operaciones consecutivas por enfermedad benigna del tracto biliar. Se pudo identificar una serie de factores de alto riesgo en relación a bacteriología positiva y a complicaciones sépticas: pacientes de edad avanzada (>70 años;p<0.001), pacientes diabéticos, pacientes con nivel de bilirrubina sérica mayor de 1.1 mg% (p<0.001) pacientes con colecistitis aguda (p<0.001) y pacientes en quienes se encontraron cálculos en el colédoco (p<0.001). Utilizando un análisis multivariable, llegamos a la conclusión de que en los pacientes sin factores de riesgo (56% de la serie) la incidencia de bacteriología positiva es baja (10.9%) y que no deben recibir profiliaxis antibiótica. Los pacientes con un factor de riesgo (24% de la serie) exhibieron una incidencia de 36% de bacteriología positiva; para ello se recomienda mínima profilaxis preoperatoria. Los pacientes con dos o más factores de riesgo (19.1% de la serie) exhibieron una incidencia de 77.6% de bacteriología positiva, y en ellos se recomienda profilaxis antibiótica total, comenzando en el período preoperatorio y continuandola por tres a cinco días postoperatorios. El próposito de este estudio fue el de indentificar pacientes con alto riesgo de desarrollar complicaciones con la cirugía biliar y crear nuevas directrices para el tratamiento antibiótico en grupos seleccionados.
Similar content being viewed by others
References
Polk, H.C.: Diminished surgical infection by systemic antibiotics administration in potentially contaminated antibiotics. Surgery75:312, 1974
Renvall, S., Niinikoski, J., Aho, A.J.: Wound infection in abdominal surgery: A prospective study on 696 operations. Acta Chir. Scand.146:25, 1980
Kaufman, Z., Engelberg, M., Eliashiv, A., Reiss, R.: Systemic prophylactic antibiotics in elective biliary surgery. Arch. Surg.119:1002, 1984
Keighley, M. R., Flinn, R., Williams, J.A.: Multivariate analysis of clinical and operative findings associated with biliary sepsis. Br. J. Surg.63:528, 1976
Cox, J.L., Helfrich, L.R., Pass, H.I., Osterhaut, S., Shingleton, W.W.: The relationship between biliary tract infection and postoperative complications. Surg. Gynecol. Obset.146:233, 1978
Fukunaga, F.H.: Gallbladder bacteriology history and gallstones. Arch. Surg.106:69, 1973
Dooley, J.S., Hamilton-Miller, J.M., Brumfitt, W., Sherlock, S.: Antibiotics in the treatment of biliary infection. Gut25:988, 1984
Meyer, W.S., Schmitz, P.I.M., Jeekel, J.: Meta-analysis of randomized controlled clinical trials of antibiotic prophylaxis in biliary tract surgery. Br. J. Surg.77:283, 1990
Reiss, R., Eliashiv, A., Deutsch, A.A.: Septic complication and bile cultures in 800 consecutive cholecystectomies. World J. Surg.6:195, 1982
Reiss, R., Deutsch, A.A., Nudelman, I.: Biliary surgery in diabetic patients: Statistical analysis of 189 patients. Dig. Surg.4:37, 1987
Scott, A.J.: Progress report: Bacteria and biliary tract. Gut12:487, 1971
Keighly, M.R.B.: A controlled trial of gentamicin therapy in biliary surgery. Br. J. Surg.62:275, 1975
Pyrtex, L.J., Bartus, S.: An evaluation of antibiotics in biliary tract surgery. Surg. Gynecol. Obstet.125:100, 1967
Gutman, H., Deutsch, A.A., Nudelman, L.I., Reiss, R.: Cholecystectomy for octogenerians. Dig. Surg.5:189, 1988
Lewis, L.T., Goodall, G. Marien, B., Park, M., Lloyd-Smith, W., Wiegand, F.M.: Biliary bacteria, antibiotic use and wound infection in the gallbladder and the common bile duct. Arch. Surg.122:44, 1987
Reiss, R., Deutsch, A.A., Sternberg, A.: Selective antibiotic prophylaxis in biliary surgery. Int. Surg.69:13, 1984
Kaufman, Z., Dinbar, A.: Single dose prophylaxis in elective cholecystectomy. A prospective, double-blind randomized study. Am. J. Surg.152:513, 1986
Strachan, C.J., Black, J., Powis, S.J.A. Waterworth, A., Wise R., Wilkinson, A.R., Burdon, D.W., Severn, M., Mitra, B., Norcott, H.: Prophylactic use of cephazolin against wound sepsis after cholecystectomy. Br. Med. J.1:1254, 1976
Wells, G.R., Taylor, E.W., Lindsay, G., Morton, L.: Relationship between bile colonization, high risk factors and postoperative sepsis in patients undergoing biliary tract operations while receiving prophylactic antibiotics. Br. J. Surg.4:374, 1989
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Landau, O., Kott, I., Deutsch, A.A. et al. Multifactorial analysis of septic bile and septic complications in biliary surgery. World J. Surg. 16, 962–964 (1992). https://doi.org/10.1007/BF02067003
Issue Date:
DOI: https://doi.org/10.1007/BF02067003