Biliary tract surgery: a bacteriologic and epidemiologic study.
The sources and routes of postoperative wound infections were prospectively studied in 440 patients undergoing biliary tract surgery. The overall infection rate was 7.3%. Specimens for culture were taken peroperatively from bile, liver bed and subcutaneous fat in 402 patients and also from skin in 64. Of the 126 patients with positive bile culture (31%), all but one had bacteria in the other intraoperative cultures, with high counts of bile bacteria in liver bed and transfer of such bacteria to subcutaneous fat in 81.2%. The wound infection rate in this group was 12.8%. Of the 276 patients with sterile bile, more than 90% had bacteria in the other intraoperative cultures. The degree of contamination was low, with dominance of typical skin bacteria, and the group wound infection rate was 3.2%. In 19 postoperative wound infections intraoperative cultures were available for comparison. Eleven of these infections were classified as endogenous, six as exogenous and two as of uncertain origin. S. aureus was uncommon in bile and intraoperative wound cultures, but was almost as common as E. coli in the etiology of postoperative wound infections, indicating high pathogenicity.
Hambraeus
A
A
Department of Hospital Infection, University Hospital, Uppsala, Sweden.
Laurell
G
G
Nybacka
O
O
Whyte
W
W
D000328:Adult; D000368:Aged; D000818:Animals; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000382:microbiology*; D001646:Bile / Q000382:microbiology; D002763:Cholecystectomy; D002769:Cholelithiasis / Q000601:surgery*; D004285:Dogs; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000382:microbiology*