Bacteriological analysis and treatment strategy in patients with biliary sepsis

Abstract

Objectives To access the bacteriology in patients with sepsis due to biliary tract infection to provide a basis for empirical selection of proper antibiotic treatment. Methods This is a single-center retrospective study on 214 patients with biliary tract infection admitted from August 2014 to July 2016 to the surgical intensive care units (ICU) of The First Affiliated Hospital of Sun Yat-sen University. To study the demographic information, sequential organ failure assessment (SOFA), usage of antibiotics before ICU and duration of ICU were analyzed. Bile, peritoneal drainage and blood samples were collected. Results 47 septic shock patients and 25 septic patients due to biliary tract infection were enrolled in the trial. The two groups (the shock group vs. the sepsis group) had a significant difference in the duration of ICU stay [(6.4±4.6) d vs. (2.3±1.8) d, P<0.05]. 48 strains of pathogens were isolated from the bile samples. The major pathogens were Escherichia coli (E. coli) (n=23, 47.9%), Enterococcus faecalis (n=8, 16.7%) and Enterococcus faecium (n=2, 4.2%). 80 strains of pathogens were isolated from the peritoneal drainage culture samples. E. coli, pseudomonas aeruginosa, and Klebsiella pneumoniae ranked the top 3 species, accounting for 26.3%, 11.3% and 7.5%, respectively. The sensitivity of E. coli isolated from bile to amikacin, imipenem and panipenem were all over 90.0%. Conclusions E. coli was the principal gram-negative bacterium in biliary infection induced sepsis. Early administration of carbapenemes may reduce the occurrence of septic shock in these patients. Key words: Antibiotics; Biliary tract infection; Sepsis; Bacteriological analysis