DOI: https://dx.doi.org/10.18203/2349-2902.isj20222235
Published: 2022-08-26

Microbiological profile of bile culture and its antimicrobial susceptibility pattern in endo-biliary stented patients undergoing cholecystectomy

Komal Prasad Dewangan, Srinivasa Rao Geddam, Partha Sarathi Nayak

Abstract


Background: The vast majority of common bile duct (CBD) stones was secondary, formed within the gall bladder (GB) and migrates down the cystic duct into CBD or rarely due to primary stones formed in CBD. Intra-operative bile culture prevents development of infectious complications and guide selection of future appropriate antibiotic prophylaxis. Hence, this study focussed on investigation of microbiological profile of routine bile cultures in endo-biliary stenting patients undergoing cholecystectomy.

Methods: In this study, 50 patients with CBD stone(s) were undergone endoscopic retrograde cholangio-pancreatography (ERCP) followed by stenting and then cholecystectomy (either laparoscopically or open). GB extraction was done in a sterile bag and after opening sterile bag; bile was collected and sent for microbiological culture and sensitivity for analysis.

Results: Most of the cases had cholelithiasis with choledocholithiasis (38.0%) which were significantly higher than other diagnosis (Z=2.51; p<0.05) and there was no significant association found between surgical site infections and bile culture positivity of studied patients (Z=9.61; p<0.0001). Among 35 patients with positive bile cultures, E. coli in 26 patients followed by Klebsiella species in 5 patients were the most prevalent bacteria isolates and over all, colistin (91.4%) and tigecycline (91.4%) were found as sensitive antibiotics. Also, certain strains of multi drug resistance E. coli in 6 patients were resistant to gentamicin/amikacin only sensitive to tigecycline and colistin, which was high.

Conclusions: Most prevalent isolates microorganism is gram negative bacteria that were mostly gut bacteria and the incidence of post ERCP infection is high and drug resistance among the causative organism is common.


Keywords


Common bile duct stones, Gall bladder, Bile culture, Surgical site infections, Antibiotics

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References


Steiner CA, Bass EB, Talamini MA, Pitt HA, Steinberg EP. Surgical rates and operative mortality for open and laparoscopic cholecystectomy in Maryland. N Eng J Med. 1994;330(6);403-8.

Ko C, Lee S. Epidemiology and natural history of common bile duct stones and prediction of disease. Gastrointest Endosc. 2002;56(6):165.

Tierney S, Pitt HA. Choledocholithiasis and cholangitis. In: Bell RH, Rikkers LF, Mulholland MW, eds. Digestive tract surgery: a text and atlas. Philadelphia: Lippincott-Raven; 1996: 407-31.

Ahmed M, Kanotra R, Savani GT, Kotadiya F, Patel N, Tareen S, et al. Utilization trends in inpatient ERCP: A cross-sectional US experience. Endosc Int Open. 2017;5(4):261-71.

Harris A, Chan AC, Torres-Viera C, Hammett R, Carr-Locke D. Meta-analysis of antibiotic prophylaxis in endoscopic retrograde cholangio-pancreatography (ERCP). Endoscopy. 1999;31(9):126-30.

Reinders JS, Goud A, Timmer R, Kruyt PM, Witteman BJM, Smakman N, et al. Early laparoscopic cholecystectomy improves outcomes after endoscopic sphincterotomy for choledochocystolithiasis. Gastroenterology. 2010;138(7):2315-20.

Salman B, Yilmaz U, Kerem M, Bedirli A, Sare M, Sakrak O, et al. The timing of laparoscopic cholecystectomy after endoscopic retrograde cholangio-pancreatography in cholelithiasis coexisting with choledocolithiasis. J Hepatobiliary Pancreat Surg. 2009;16(6):832-6.

Sugiyama M, Atomi Y. Endoscopic Ultrasonography for diagnosing choledocholithiasis: A prospective comparative study with Ultrasonography and computed tomography. Gastrointest Endosc 1997;45(2):143-6.

Hallal AH, Jose D Amortegui, Jeroukhimov IM, Casillas J, Schulman CI, Manning RJ, et al. Magnetic resonance cholangio-pancreatography accurately detects common bile duct stones in resolving gallstone pancreatitis. J Am Coll Surg. 2005;200(6):869-75.

Behrns KE, Ashley SW, Hunter JG, Carr-Locke D. Early ERCP for gallstone pancreatitis: for whom and when? J Gastrointest Surg. 2008;12(4):629-33.

Pokharel N, Rodrigues G, Shenoy G. Evaluation of septic complications in patients undergoing biliary surgery for gall stones in a tertiary care teaching hospital of south india. Kathmandu Univ Med J. 2007;5(3):371-3.

Deviere J, Motte S, Dumonceau JM, Serruys E, Thys JP, Cremer M. Septicemia after endoscopic retrograde cholangio-pancreatography. Endoscopy. 1990;22(2):72-5.

James EC, Collin DB. Sepsis complications in endoscopic retrograde cholangio-pancreatography. Am Surg. 1976;42(4):229-32.

Nomura T, Shirai Y, Hatakeyama K. Impact of bactibilia on the development of postoperative abdominal septic complications in patients with malignant biliary obstruction. Int Surg. 1999;84(3):204-8.

Mullen JT, Lee JH, Gomez HF, Ross WA, Fukami N, Wolff RA, et al. Pancreaticoduodenectomy after placement of endobiliary metal stents. J Gastrointest Surg. 2005;9(8):1094-105.

Jagannath P, Dhir V, Shrikhande S, Shah RC, Mullerpatan P, Mohandas KM. Effect of preoperative biliary stenting on immediate outcome after pancreaticoduodenectomy. Br J Surg. 2005;92(3):356-61.

Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: Incidence and impact on hospital utilization and treatment costs. Am J Infect Control. 2009;37(5):387-97.

Dorman JP, Franklin ME, Glass JL. Laparoscopic common bile duct exploration by choledochotomy: an effective and efficient method of treatment of choledocholithiasis. Surgical Endoscopy. 1998;12(7):926-8.

Chandrakasan C, Reddy VV, Musunura BR, Reddy DA, Dasari V, Pagadala NNB. Correlation of intra-operative bile cultures with septic complications following biliary tract surgery. Int Surg J. 2016;3(4):2177-80.

Kondo K, Chijiiwa K, Ohuchida J. Selection of prophylactic antibiotics according to the microorganisms isolated from surgical site infections (SSIs) in a previous series of surgeries reduces SSI incidence after pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci. 2013;20(3):286-93.

Khuroo MS, Mahajan R, Zargar SA, Javid G, Sapru S. Prevalance of biliary tract disease in India: a sonographic study in adult population in Kashmir. Gut. 1989;30(2):201-5.

Rai MK, Kumar V. Incidence of cholelithiasis in gallstone disease in eastern zone of India: a single centre study. Int J Med and Dent Sci. 2017;6(1):1417-20.

Mandryka Y, Klimczak J, Duszewski M, Kondras M, Modzelewski B. Bile duct infections as a late complication after endoscopic sphincterotomy. Pol Merkur Lekarski. 2006;21(126):525-7.

Maurer KJ, Carey MC, Fox JG. Roles of infection, inflammation, and the immune system in cholesterol gallstone formation. Gastroenterology. 2009;136(2):425-40.