Modern Approaches to Antibiotic therapy in Acute Cholangitis

Abstract

Objective — to study microflora characteristics in bacteriological study of bile, and to determinate the sensitivity of this microflora to modern antibacterial agents.
 Materials and methods. In 43 operated patients with acute purulent cholangitis for bacteriological examination, a bile was collected from the lumen of the common bile duct during the open surgical operation on extrahepatic bile ducts, also from the choleldosostomy drainage tube in the postoperative period and during retrograde endoscopic diagnostic and therapeutic manipulations. Antibiotic susceptibility of aerobic microorganisms was determined by the disc diffusion method, anaerobic — using АТВ ANA test systems.
 Results and discussion. It is established that the structure of microflora, which cultivated with the test material, the main place occupied mainly aerobic bacteria Escherichia group (51 %). In cultivated microbial associations manifested dominance of gram-negative microorganisms and bacteria of the type of anaerobic metabolism. The highest level of sensitivity of aerobic microorganisms to antibiotics manifested itself with preparations of the group of cephalosporins III—IV generation, fluoroquinolones II—III generation and carbapenems — in 68 %, 62 % and 87 % of observations, respectively. Sensitivity of microorganisms to preparations of cephalosporin І generation was observed only in 19 % and II — in 20 % of cases. The assessment of antibiotic susceptibility of anaerobic microflora showed virtually absolute levels to protected penicillins (piperacillin + tazobactam, ticarcillin + clavulanic acid). And the sensitivity of these microorganisms to imipenem, cefotaxime and clindamycin was 97 %, 91 % and 94 %, respectively.
 Conclusions. In the structure of the microflora in acute purulent cholangitis, aerobic bacteria of the intestinal group and gram-negative microflora with anaerobic type of metabolism prevailed.Aerobic microorganisms exhibited high antibiotic susceptibility to cephalosporins of the III—IV generation, fluroquinolones of the II—III generation and carbapenems, and anaerobic bacteria — protected penicillins, cephalosporins and carbapenems. Etiotropic antibiotics should be administered within 10—14 days.