| Popis: |
Background Biliary stasis and increased intraductal pressure are central to the pathogenesis of acute cholangitis. Biliary stasis inhibits the continuous flushing activity of bile and the bacteriostatic effect of bile salts, which help maintain bile sterility. Elevated intraductal pressure favors translocation of bacteria and toxins out of the ducts and into the systemic circulation, which can result in sepsis. Sepsis is among the most common causes of mortality for hospitalized patients worldwide, and its incidence is steadily increasing. Aims To characterize clinical manifestation and identify bacteria of secondary sepsis from hepatic disease and cholestasis. Methods We conducted a prospective study of 38 patients with secondary sepsis from hepatic disease and cholestasis at the 108 Military Central Hospital from January 2018 to August 2019. Contributions of the history, physical examination, laboratory investigation and subclinical in making medical diagnoses. PCR-based Sepsis@Quick test is for identification of sepsis-causative pathogens. Results On examination: fever (100%); abdominal pain (39.5%) and jaundice (100%). Laboratory investigation: White blood cell (16.98 ± 8.46 G/L); Neutrophil (85.3 ± 10.82%); Procalcitonin (21.18 ± 27.16 ng/ml). Procalcitonin values demonstrated a statistically significant and directly proportionate relationship to severity of sepsis. Secondary sepsis from cholestasis: biliary tract cancer 28.9%; gallstone 28.9%; pancreatic cancer 10.5%. Secondary sepsis from hepatic diseases: hepatocellular carcinoma 13.2%; cirrhosis 10.5%; liver abscess 7.9%. Sepsis-causative pathogens: Escherichia coli 55.3%; Klebsiella pneumoniae 31.6%; Citrobacter koseri 2.6%; Streptococcus anginosus 2.6%; Enterococcus faecalis 2.6%; Citrobacter freundii 2.6%; Klebsiella oxytoca 2.6%; Pseudomonas aeruginosa 2.6%. Conclusions Etiology of secondary sepsis from hepatic disease and cholestasis the most is Escherichia coli, second is Klebsiella pneumoniae, of these we find Escherichia coli most commonly in gallstones, Klebsiella pneumonia most commonly in cholangiocarcinoma. |
