RESUMO
BACKGROUND: The role of bactibilia as a risk factor for an unfavorable outcome during biliary disease or surgical procedures remains obscure. Our aim was to identify possible risk factors for bactibilia and their possible relations to complications after elective cholecystectomy. As secondary aims, composition and antibiotic resistance patterns were studied. METHODS: Bile and gallbladder mucosa samples from 358 elective cholecystectomies were collected prospectively between June 2009 and June 2012. Ordinary microbiologic cultures and antibiograms were performed. All pre-operative factors associated with bactibilia were studied by stepwise logistic regression multivariable analysis. RESULTS: The bacteria isolated most frequently from 103 positive cultures were Escherichia coli (21.3%), Enterococcus spp. (14.7%), and Enterobacter spp. (14.7%) with a global amoxicillin-clavulanic acid resistance rate of 53.7%. Age >65 y, male gender, previous instrumentation or disease of the biliary tract, and high American Society of Anesthesiologists score were independent risk factors. No correlation was found between bactibilia and surgical complications. CONCLUSIONS: Although the influence of bactibilia in developing surgical complications is limited, its composition and the high rate of resistance can be influential enough to modify antibiotic treatment in biliary tract infections, especially in high-risk patients.
Assuntos
Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Bile/microbiologia , Colecistectomia , Farmacorresistência Bacteriana , Vesícula Biliar/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bactérias/classificação , Técnicas Bacteriológicas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto JovemRESUMO
Because splenectomy has been linked to overwhelming infection years ago, management of splenic traumatisms has become progressively conservative. To assess the immunological function of the spleen in patients with splenic traumatism of different intensity, 43 patients with splenic injury (grades I through V) undergoing either nonoperative management, splenectomy, splenectomy with autotransplantation, or splenic embolization were analyzed for lymphocyte subpopulations and antibody responses to Streptococcus pneumoniae and Haemophilus influenzae vaccinations. Patients treated with splenectomy exhibited a significant decrease in CD4+ T lymphocytes and in Immunoglobulin (Ig) M(high)IgD(low) B cells (related to T-cell independent responses). Median fluorescence intensity of CD54+ in B cells also was reduced. The percent of IgM(high)IgD(low) B cells-a marker of marginal zone function-was inversely correlated with the number of pitted-red blood cells-a marker of red pulp function loss. IgM anti-S pneumoniae identified those patients with a defective rapid response to polysaccharide antigens. These results reinforce the importance of conservative options in the treatment of splenic traumatism for even a severely damaged organ. Despite the significant differences among the groups reported, it remains difficult to predict the IgM response to S pneumoniae vaccine of the individual patients. Better markers to assess splenic function and vaccination response after severe splenic traumatism-even in patients with nonoperative management-might improve risk assessment for overwhelming postsplenectomy infection.
