A prospective observational study to study and correlate the clinical and microbiological profile of bile cultures in patients with symptomatic cholelithiasis
Keywords:Bile culture, Biliary microflora, Cholelithiasis, Prophylactic antibiotic
Background: Biliary infection has been reported in a significant proportion of patients developing gallstones. Many studies have found biliary microflora in 20% to 46% patients with a post-operative infection rate of 7% to 20% in those who undergo cholecystectomy for symptomatic gallstone disease. Various antibiotics are also used empirically as prophylaxis against post-operative infection. The study was conducted in order to determine the bacteriology and to test its sensitivity to commonly used antibiotics of aspirated bile samples taken during laparoscopic cholecystectomy, and to correlate it with the clinical profile recorded in patients with symptomatic cholelithiasis.
Methods: A total of 266 patients who underwent laparoscopic cholecystectomy were included in the study over a two year period. Intra operatively, bile was aspirated from gall bladder and sent for culture and antibiotic sensitivity testing.
Results: 14.66% (39 out of 266) patients had positive growth with Escherichia coli most commonly isolated in 9.77% (26/266) patients, followed by the Klebsiella species in 4.89% (13 out of 266) patients. All the cultures were sensitive to amikacin and meropenem, 97.44% to imipenem, and only 43.39% were sensitive to ampicillin. A statistically significant correlation was observed between a positive bile culture with the duration of symptoms (p=0.01874) and gall bladder thickness (p<0.0001). No correlation was seen between bile culture and history of acute cholecystitis, number or size of calculi.
Conclusions: The results of this study can help develop local guidelines and recommendations based on Indian data to ensure the rational use of prophylactic antibiotics in patients with symptomatic cholelithiasis.
Bansal A, Akhtar M, Bansal A. A clinical study: prevalence and management of cholelithiasis. Int Surg J. 2014;1(3):134-9.
Abeysuriya V, Deen KI, Wijesuriya T, Salgado SS. Microbiology of gallbladder bile in uncomplicated symptomatic cholelithiasis. Hepatobiliary Pancreat Dis Int. 2008;7(6):633-7.
Bae WK, Moon YS, Kim JH, Lee SH, Kim NH, Kim KA, et al. Microbiologic study of the bile culture and antimicrobial susceptibility in patients with biliary tract infection. Korean J Gastroenterol. 2008;51:248-54.
Ahmad F, Islahi S, Hingora OM, Singh YI. Cholelithiasis a clinical and microbiological analysis. Int J Scientific Study. 2014;2(4):40-5.
Sattar I, Aziz A, Rasul S, Mehmood Z, Khan A. Frequency of infection in cholelithiasis. J Coll Physicians Surg Pak. 2007;17(1):48-50.
Parekh P, Shah N, Suthar P, Patel D, Mehta C, Tadvi H. Bacteriological analysis of bile in cholecystectomy patients. Int J Res Med Sci. 2015;3(11):3091-6.
Shrestha KR, Adhikary S, Koirala R, Amatya R. Frequency of bile bacteria in gallstone disease. J Institute Med. 2014;36(1):34-7.
Darkahi B, Sandblom G, Liljeholm H, Videhult P, Melhus Å, Rasmussen I. Biliary microflora in patients undergoing cholecystectomy. Surg Infec. 2014;15(3):262-5
Stiff MG, O'Donohue P, Ogunbiyi S, Sheridan W. Microbiological assessment of bile during cholecystectomy: is all bile infected? HPB. 2007;9(3):225-8.
Ahmad M, Akhtar MR, Ali A, Ahmad A, Hashmi JS. Microbiology of bile in symptomatic uncomplicated gallstone disease. Pak Armed Forces Med J. 2015;65(4):22-9.
Bistgani M, Imani R. Bile bacteria of patients with cholelithiasis and their antibiogram. Acta Medica Iranica. 2013;51(11):779-83.
Gomes PR, Fernando SS, Weerasekara DD, Velathanthiri VG, Rizny MS, Weerasekara MM, et al. Aerobic bacteria associated with symptomatic gallstone disease and their antimicrobial susceptibility. Galle Med J. 2006;11(1):9-13.
Capoor M, Nair D, Rajni, Khanna G, Krishna S, Chintamani M, et al. Microflora of bile aspirates in patients with acute cholecystitis with or without cholelithiasis: a tropical experience. Brazilian J Infec Dis. 2008;12(3):222-5.