MICROBIOLOGICAL STUDY OF BILE IN PATIENTS WITH ACUTE PURULENT CHOLANGITIS

Abstract

Abstract. Bacteremia and endotoxemia are observed in patients with acute purulent cholangitis. Infection of the biliary system can occur in different ways: ascending (enterogenic), descending (hematogenic) and lymphogenic. To date, there is no complete clarity about each of the ways bacteria enter the bile. The prevailing opinion is that the most common cause of biliary colonization is enterogenic and lymphogenic spread of microorganisms from the intestine. For the development of infection, penetration into the bile is not enough. Along with bile stagnation, damage to the bile duct mucosa and changes in the physicochemical properties of bile are important. The aim of the study. To conduct a bacteriological study of bile microflora and to find out its role in the etiology of acute purulent cholangitis. Materials and methods. To characterize the microflora, to clarify its role in the etiology of acute purulent cholangitis, as well as for the purpose of dynamic monitoring of bacterial contamination of bile, its bacteriological study was performed. Bacteriologic examination of bile was performed in 101 patients with acute purulent cholangitis with mechanical jaundice of non-tumor origin. The results. Positive cultures were obtained in all patients. The analysis of bacteriological studies showed that in 89,1% of patients the cause of acute purulent cholangitis was the association of aerobic and anaerobic microorganisms. In 6,9% of patients, only nonclostridial anaerobes were sown, in 4% – only aerobes. The analysis of the species structure of the bile microflora revealed the following: the aerobic revealed the following: the aerobic spectrum of the bacterial flora was represented by various enterobacteria, Escherichia coli, various types of Proteus, staphylococci, and streptococci. E. coli was the dominant infectious agent. Conclusions. A correlation between the severity of the disease and the nature of the bile microflora was found. In patients with severe purulent intoxication and severe liver failure, associations of Escherichia coli and bacteroids were involved in the inflammatory process, among which Bact. Fragilis. The data obtained are of great importance for the complex therapy of acute purulent cholangitis.