Novosti
Khirurgii
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Year 2012 Vol. 20 No 2

GENERAL AND SPECIAL SURGERY

YU.S VINNIK, .V. SEROVA, R.A. PAKHOMOVA, .V. PERYANOVA, .V. RUKOSUEVA

ROLE OF BACTERIAL FACTOR IN PROGRESSION OF ACUTE CALCULOUS CHOLECYSTITIS

SBEE HPE Krasnoyarsk State Medical University named after professor V.F.Voyno-Yasenetsky
The Russian Federation

Objectives. To improve the treatment results of patients with acute calculous cholecystitis.
Methods. 125 patients with acute calculous cholecystitis (ACC) were examined. The first group included the patients in whom traditional conservative treatment was performed (49 patients). The second group was made up of the patients in whom pre-surgical etiotropic preventive antibiotics and rational post-surgical preventive antibiotics were used (76 people). In both groups bacteriologic examination of cystic bile, biopsy material of the gall bladder wall and biliary calculus was carried out. In the second group PCR method was applied the identification of anaerobic microflora in the blood, cystic bile and biopsy material of the gall bladder wall.
Results. High percentage of positive results of inoculation was received at phlegmonous calculous cholecystitis 85,7% and at gangrenous calculous cholecystitis 84,2%. In the investigated samples the representatives of family Enterobacteriaceae prevailed. E. faecium hold the second place among all isolated cultivations. Gram-positive cocci were also represented by S. epidermidis and anaerobic cocci P. constellatus. Moraxella spp. and Pseudomonas spp. were also marked.
The highest percentage of the identified monocultures of anaerobic organisms was received during the examination of cystic bile (86,2%) and biopsy material of the gall bladder wall (92,1%) at the deconstructive forms of calculous cholecystitis.
Etiological role of anaerobic microorganisms in the progression of complicated forms of cholelithiasis was determined by PCR method in 65,5% cases.
Resistance to amikacin, gentamicin, sparfloxacine and ciprofloxacin was determined in E.coli. Pseudomonas aeruginosa is resistant to cefoperazone. Strains of P. constellatus are resistant to metronidazole.
Conclusions. One of the leading etiological factors in the progression of deconstructive forms of calculous cholecystitis is anaerobic microorganisms, which can hardly be identified by bacteriological method. PCR method is the method of choice in diagnostics of anaerobes.
Most allocated strains of microorganisms are sensitive to investigated antimicrobials. Resistance of anaerobic microorganisms to metronidazole was revealed.
Prescription of antimicrobial chemical drugs on the basis of the evaluation of microorganism sensibility results authentically allows decreasing the percentage of postoperative complications that patients with ACC can have.

Keywords: cholelithiasis, acute calculous cholecystitis, microflora of biliary system, rational antimicrobial chemotherapy
p. 20 24 of the original issue
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Address for correspondence:
660022, Rossiiskaia Federatsiia, g. Krasnoiarsk, ul. Partizana Zhelezniaka, d. 1, GBOU VPO Krasnoiarskii gosudarstvennyi meditsinskii universitet, kafedra obshchei khirurgii,
e-mail: ekaterina_s_07@mail.ru,
Serova Ekaterina Valer'evna
Information about the authors:
Vinnik Yu.S., doctor of medical sciences, professor, a Honored Scientist of Russia, a head of the general surgery chair of SBEE HPE Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky ".
Serova E.V., candidate of medical sciences, assistant the general surgery chair of SBEE HPE Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky ".
Pakhomova R.A., candidate of medical sciences, an assistant the general surgery chair of SBEE HPE Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky ".
Peryanova O.V., candidate of biological sciences, associate professor of the microbiology chair named after associate professor B.M.Zelmanovich of SBEE HPE Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky ".
RukosuevaT.V., a senior lecturer of the microbiology chair named after associate professor B.M.Zelmanovich of SBEE HPE Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky ".
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