Upotreba mikrobioloških i laboratorijskih nalaza u izboru empirijske antibiotske terapije u bolesnika podvrgnutih laparoskopskoj kolecistektomiji - uloga lokalnih antibiograma

Autor: Pašić, Fuad, Delibegović, Samir
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Acta clinica Croatica
Volume 61.
Issue 2
ISSN: 1333-9451
0353-9466
Popis: Antibiotic therapy is indicated during acute cholecystitis. However, in the treatment of uncomplicated cholelithiasis, prophylactic use of antibiotics is controversial. Microbiological and laboratory data are the basis for the choice of antibiotic treatment. However, monitoring and updating local antibiograms is important because they ensure effective therapy in the given clinical environment. The study included 110 consecutive patients who underwent laparoscopic cholecystectomy, divided into the group of uncomplicated cholelithiasis (n=60) and the group of acute cholecystitis (n=50). Preoperative data included age, sex, body mass index, leukocytes, C-reactive protein, and ultrasound examination. Bile samples for bacteriological testing were obtained under aseptic conditions during the surgery. Cultures were evaluated for aerobic, anaerobic and fungal organisms using routine tests. After the surgery, gallbladder specimens were sent for histopathological examination. In the group of uncomplicated cholelithiasis, 6/60 positive samples were found, and in the group of acute cholecystitis, there were 25/50 positive microbiological findings. Citrobacter sp. and Enterococcus faecalis predominated in the group of uncomplicated cholelithiasis, and Escherichia coli, Enterococcus faecalis, Proteus mirabilis and Citrobacter sp. in the group of acute cholecystitis. Antibiotics were administered to 49/50 patients with acute cholecystitis and to 32/60 patients with uncomplicated cholelithiasis. Cefazolin was the most frequently used antibiotic and also the most resistant antibiotic. To conclude, the administration of antibiotics in elective patients is not justified. The results of this study indicate that third-generation cephalosporin or ciprofloxacin + metronidazole should be administered in mild and moderate acute cholecystitis, and fourth-generation cephalosporin + metronidazole in severe acute cholecystitis in this local setting. The appropriate use of antibiotic agents is crucial and should be integrated into good clinical practice and standards of care.
Antibiotska terapija je indicirana u liječenju akutnog kolecistitisa. Međutim, u liječenju nekomplicirane kolelitijaze profilaktična upotreba antibiotika je proturječna. Mikrobiološki i laboratorijski podaci su osnova za izbor antibiotske terapije. Stoga su nadzor i lokalni antibiogrami vrlo važni, jer daju djelotvornu terapiju u datom kliničkom okruženju. U istraživanje je bilo uključeno 110 bolesnika koji su podvrgnuti laparoskopskoj kolecistektomiji. Bolesnici su podijeljeni u dvije skupine: skupina s nekompliciranom kolelitijazom (n=60) i skupina s akutnim kolecistitisom (n=50). Prijeoperacijski podaci su uključivali dob, spol, indeks tjelesne mase, leukocite, C-reaktivni protein te ultrasonografski pregled. Uzorci žuči za bakteriološka testiranja uzeti su pod aseptičkim uvjetima tijekom kirurškog zahvata te evaluirani na aerobnu i anaerobnu floru i fungalne organizme primjenom rutinskih testova. Nakon kirurškog zahvata uzorci žučnog mjehura poslani su na patohistološku analizu. U skupini s nekompliciranom kolelitijazom pronađeno je 6/60 pozitivnih nalaza, a u skupini s akutnim kolecistitisom 25/50 pozitivnih mikrobioloških nalaza. U skupini s nekompliciranom kolelitijazom prevladavali su Citrobacter sp. i Enterococcus faecalis, a u skupini s akutnim kolecistitisom Escherichia coli, Enterococus faecalis, Proteus mirabilis, Citrobacter sp. U skupini s nekompliciranom kolelitijazom antibiotici su davani u 32/60 slučajeva, a u skupini s akutnim kolecitistisom u 49/50 slučajeva. Najčešće primijenjeni antibiotik bio je cefazolin, koji je bio također i najrezistentniji antibiotik. Može se zaključiti da davanje antibiotika elektivnim bolesnicima nije opravdano. Rezultati ove studije upućuju na to da u ovom kliničkom okruženju cefalosporin treće generacije ili ciprofloksacin + metronidazol treba davati kod blagog i umjerenog akutnog kolecistitisa, a u teškim slučajevima cefalosporin četvrte generacije + metronidazol. Primjerena upotreba antibiotika je presudna i treba biti integralni dio dobre kliničke prakse i standardne skrbi.
Databáze: OpenAIRE
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