• Users Online: 165
  • Print this page
  • Email this page


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 1  |  Issue : 1  |  Page : 3-6

Bacteriological profile of bile in cholecystectomy patients in tertiary care center


1 Department of General Surgery, Lala Lajpat Rai Memorial Medical College, Meerut, Uttar Pradesh, India
2 Department of Microbiology, National Capital Region Institute of Medical Sciences, Meerut, Uttar Pradesh, India

Date of Submission28-Apr-2022
Date of Decision10-May-2022
Date of Acceptance12-May-2022
Date of Web Publication17-Jun-2022

Correspondence Address:
Sunil Kaval
Lala Lajpar Rai Memorial Medical College, Meerut - 250 004, Uttar Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/wjsi.wjsi_9_22

Rights and Permissions
  Abstract 


Aims and Objectives: This study was done to evaluate the microbiological profile of bile from the gall bladder in patients undergoing cholecystectomy and to determine the appropriate antibiotic for preoperative prophylaxis in cholecystectomy patients based on the microbiological profile of bile.
Materials and Methods: A retrospective study done with 126 patients with a diagnosis of cholecystolithiasis postoperated of laparoscopic cholecystectomy had surgery department their bile sent to the Department of Microbiology, Lala Lajpat Rai Memorial Medical College, Meerut (UP) from October 2017 to November 2018.
Results: A total of 126 patients were included in this study, of which the male-to-female ratio was 1:2.71, while females were 92 (83%) and males were 34 (17%). The age of the patients ranged from 01 to >61 years of age, in which the maximum number of patients was in the 41–60 age group 78 (62%). In the microbiological analysis, only 68 (54%) samples were culture positive, in which the most common organism isolated was Escherichia coli 43 (63.2%) and the second-most common was Klebsiella spp. 17 (25%).
Conclusions: Therefore, it is important to know about common bacteria causing gallbladder infection and their antibiotic resistance pattern. This study may be helpful in designing antibiotic prophylaxis among these patients.

Keywords: Analysis, antibiotic sensitivity, bile, cholecystectomy


How to cite this article:
Kaval S, Tewari S. Bacteriological profile of bile in cholecystectomy patients in tertiary care center. World J Surg Infect 2022;1:3-6

How to cite this URL:
Kaval S, Tewari S. Bacteriological profile of bile in cholecystectomy patients in tertiary care center. World J Surg Infect [serial online] 2022 [cited 2022 Sep 26];1:3-6. Available from: https://www.worldsurginfect.com/text.asp?2022/1/1/3/347772




  Introduction Top


Cholelithiasis is one of the most common surgical conditions affecting the gastrointestinal tract in North India and cholecystectomy is one of the most common surgeries done.[1] Bile is generally sterile but might be infected in cholelithiasis. The incidence of bactibilia varies from 10% to 70%. The incidence of bactibilia is low in uncomplicated cholelithiasis, whereas it is higher in complicated cholelithiasis cases due to obstruction and stasis.[2] The incidence of gallstone disease has a marked rise in Western countries during the past century. In the USA, UK, and Australia, the prevalence rate ranges between 15% and 25%. In India, it is a more common finding in North than South and in East than West.[3],[4] In 85%–95% of cases, inflammation of the gall bladder is associated with calculi.[5]

The most commonly isolated microorganisms among pathogens in positive bile cultures are enterococci and bacteria from the order Enterobacteriales, such as  Escherichia More Details and Klebsiella. The microbial profile of bile sampled from the gallbladder may provide more information in the context of acute cholecystitis because most such infections are limited to the gallbladder, and sampling directly from the infection site increases the likelihood of identifying the true causative pathogen.[6],[7]

The study aimed to investigate the bacteriological profile of bile of the patients undergoing cholecystectomy.


  Materials and Methods Top


The gallbladder of the patients undergoing open cholecystectomy using a sterile syringe (5 ml), but in the case of laparoscopic cholecystectomy, bile was collected from the excised gallbladder [Figure 1]. The bile was collected in a sterile container and after proper labeling; it was transferred to the microbiology laboratory. All the bile samples were inoculated on basal media such as nutrient agar, MacConkey agar, and blood agar, and incubated aerobically at 37°C temperature for 24–48 h for the growth of organisms. The bile was sterile when there was no growth even after 48 h of incubation. All positive culture was identified by their colony morphology on the plate, microscopic examination of Gram's staining, and appropriate biochemical reactions. Antimicrobial susceptibility testing was performed on Mueller–Hinton agar plates using disc diffusion method according to the Clinical and Laboratory Standard Institute guidelines.[8],[9]
Figure 1: (a) Gall bladder with multiple stones, (b) Intact gall bladder (c) Cholesterosis of gall bladder

Click here to view



  Results Top


A total of 126 patients were included in this study, of which male-to-female ratio was 1:2.71, while females were 92 (83%) and males were 34 (17%). Age of the patients ranged from 01 to >61 years in which maximum patients were in 41–60 age group 78 (62%), followed by 25 (19.8%) in age group >61, 22 (17.4%) in 21–40 age group and 1 (0.8%) in 01–20 age group [Figure 2] and [Table 1]. Out of 126 patients, 96 (76.2%) patients underwent laparoscopy cholecystectomy, in 18 (14.3%) patients open Cholecystectomy was performed and in 12 (9.5%) laparoscopy surgery was converted to open surgery [Figure 3].
Table 1: Age group-wise distribution

Click here to view
Figure 2: Sex distribution

Click here to view
Figure 3: Distribution of surgical treatment procedure

Click here to view


Out of 126 bile samples for microbiological analysis, only 68 (54%) samples were culture positive. Among the culture positive samples most common organism isolated was  Escherichia coli Scientific Name Search %), followed by Klebsiella spp. 17 (25%), 4 (6%) Pseudomonas spp., 2 (3%)  Salmonella More Details spp., and Staphylococcus aureus Scientific Name Search  and Acinetobacter 1 (1.4%) each. The remaining bile samples 58 (46%) were sterile [Figure 4].
Figure 4: Bacteriological profile of bile

Click here to view


All Gram-negative bacterial isolates showed maximum sensitive toward imipenem, meropenem, piperacillin/tazobactam, cefepime, and ceftriaxone/sulbactam. No organism was found to be resistance to colistin and polymyxin B. Among Gram-positive bacterial isolates showed sensitivity to linezolid and teicoplanin [Table 2].
Table 2: Antibiogram of the bacteria isolated

Click here to view



  Discussion Top


The study was carried out on 126 patients who were admitted our surgery unit over 1 year. In this, 54% of bile samples were showed positive bile culture. The data showed a high prevalence in Western Uttar Pradesh. Our findings contrast with other researchers. They reported a very low prevalence.[10],[11],[12],[13]

In our study, most of the cases undergoing surgery were in the age group of 41–60 years, similar findings were found in other studies. The contrast our study incidence of cholelithiasis in reported by Chuttani P N et al., was between 31 and 60 years.[3],[4],[5],[6],[14] In the present study, there were 17% of males and 83% of females with male-to-female ratio of 1:2.71. Female predominance has been observed by many researchers.[12],[14],[15],[16],[17] The most common organism E. coli was 63.2% found in bile culture, Klebsiella spp. was the second-most common organism found in 25% of the patients. Our findings were similar to other studies published by Capoor et al., Bhansali, Flores C et al., Sharma et al., and Pratik et al., and many more, the most common organism was isolated was E. coli, followed by Klebsiella spp. The reason for E. coli being the most common bacteria in bile is because it is the most common bacteria found in GIT and infection to the biliary system comes from the GIT.[18],[19],[20],[21],[22],[23]

In our study, on culture and sensitivity test, similar with Gupta et al., Khalid Anjum et al., Kumar et al., Manan et al., Bhansali, Flores et al., Pratik et al., and Fuks et al.[2],[12],[14],[17],[20],[21],[22],[23],[24]


  Conclusions Top


The bile is normally sterile in the gall bladder in the absence of gallstone or any pathology of biliary tract. There is a high incidence of bactibilia in cases of inflamed gallbladder with gallstones or biliary tract obstruction. Gram-negative organisms are more common in bile infection as they are part of normal Gastrointestinal (GI) flora and may cause ascending infection in the gallbladder. Drug resistance is a growing health problem nowadays undue and inappropriate use of antibiotics are the main cause of growing drug resistance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gill HS, Sandhu GS, Luna A, Gill AK. Bacteriological profile of bile in patients undergoing cholecystectomy. Sch Acad J Biosci 2016;4:520-5.  Back to cited text no. 1
    
2.
Gupta J, Gupta A, Gupta R, Gupta A, Devkaran B, et al. Bacteriological profile of bile and antibiogram in cholecystectomy patients. J Med Sci Clin Res 2017;5:20786-9.  Back to cited text no. 2
    
3.
Ballal M, Jyothi KN, Antony B, Arun C, Prabhu T, Shivananda PG. Bacteriological spectrum of cholecystitis and its antibiogram. Indian J Med Microbiol 2001;19:212-4.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Thompson JE Jr., Pitt HA, Doty JE, Coleman J, Irving C. Broad spectrum penicillin as an adequate therapy for acute cholangitis. Surg Gynecol Obstet 1990;171:275-82.  Back to cited text no. 4
    
5.
Kaur D, Gupta V, China RS, Sharma D, Arora C, Gupta R. Microbiological profile of biliary tract infections. J Gastrointest Infect 2015;5:20-3.  Back to cited text no. 5
    
6.
Yun SP, Seo HI. Clinical aspects of bile culture in patients undergoing laparoscopic cholecystectomy. Medicine 2018;97:e11234.  Back to cited text no. 6
    
7.
Kwon W, Jang JY, Kim EC, Park JW, Han IW, Kang MJ, et al. Changing trend in bile microbiology and antibiotic susceptibilities: Over 12 years of experience. Infection 2013;41:93-102.  Back to cited text no. 7
    
8.
CLSI. Performance Standards for Antimicrobial Susceptibility Testing. CLSI Supplement M100. 27th ed. Wayne, PA: Clinical and Laboratory Standards Institute; 2017.  Back to cited text no. 8
    
9.
CLSI. M100-S24 Performance standards for antimicrobial susceptibility testing; twenty-fourth informational supplement. Wayne, Pennsylvania: Clinical and Laboratory Standards Institute, 2014.  Back to cited text no. 9
    
10.
Sabir O. Infected Bile in Gallbladder in Cholelithiasis (Dissertation). Karachi: College of Physicians and Surgeon Pakistan; 1998.  Back to cited text no. 10
    
11.
van Leeuwen PA, Keeman JN, Butzelaar RM, Van den Bogaard AE. Correlation between a positive gallbladder culture and subsequent wound infection after biliary surgery – A retrospective study of 840 patients. Neth J Surg 1985;37:179-82.  Back to cited text no. 11
    
12.
Anjum MD, Prasad A, Ansari M, Kumar M, Seema K. Bacteriological profile of bile in cholecystectomy patients at rims, Ranchi, India. Int J Curr Microbiol App Sci 2020;9:156-60.  Back to cited text no. 12
    
13.
Cueto-Ramos R, Hernández-Guedea M, Pérez-Rodríguez E, Reyna-Sepúlveda F, Muñoz-Maldonado G. Incidence of bacteria from cultures of bile and gallbladder wall of laparoscopic cholecystectomy patients in the University Hospital “Dr. José Eleuterio González”. Cir Cir 2017;85:515-21.  Back to cited text no. 13
    
14.
Kumar M, Oraon V, Sherwal BL, Bodra P, Agrawal AK, Sharma AK, et al. Bacterial profile of bile and gall stone in symptomatic cholelithiasis patients. Int J Med Res Prof 2017;3:122-6.  Back to cited text no. 14
    
15.
Ahmad F, Islahi S, Hingora OM, Singh YI. Cholelithiasis – A Clinical and Microbiological Analysis. Int J Sci Stud. 2014;2(4):40-45.  Back to cited text no. 15
    
16.
Sabharwal ED, Chopra R, Chawla LS. Gall bladder disease pattern in Punjab. J Indian Med Assoc 1984;82:164-6.  Back to cited text no. 16
    
17.
Manan F, Khan M, Faraz A, Khan M. Frequency of common bacteria and their antibiotic sensitivity in patients with symptomatic cholelithiasis. J Postgrad Med Inst 2014;28:2.  Back to cited text no. 17
    
18.
Chhuttani PN, Sachdeva Y, Chitkara NL, Thind RS, Chawla LS. Gall bladder disease in the Punjab. Incidence and symptomatology. J Assoc Physicians India 1965;13:140-5.  Back to cited text no. 18
    
19.
Capoor MR, Nair D, Rajni, Khanna G, Krishna SV, Chintamani MS, et al. Microflora of bile aspirates in patients with acute cholecystitis with or without cholelithiasis: A tropical experience. Braz J Infect Dis 2008;12:222-5.  Back to cited text no. 19
    
20.
Bhansali SK. Preoperative complications of gallstones and their relevance to treatment and prognosis: Experience with 451 cases. Am J Gastroenterol 1985;80:648-54.  Back to cited text no. 20
    
21.
Flores C, Maguilnik I, Hadlich E, Goldani LZ. Microbiology of choledochal bile in patients with choledocholithiasis admitted to a tertiary hospital. J Gastroenterol Hepatol 2003;18:333-6.  Back to cited text no. 21
    
22.
Sharma K, Jad B, Mahajan B, Gupta S. Bacteriological analysis of bile culture from a tertiary care hospital. Int J Health Sci Res 2018;8:88-91.  Back to cited text no. 22
    
23.
Pratik MP, Nimish JS, Pokhraj PS, Devang HP, Chetan M, Hitesh DT. Bacteriological analysis of bile in cholecystectomy patients. Int J Res Med Sci 2015;3:3091-6.  Back to cited text no. 23
    
24.
Fuks D, Cossé C, Régimbeau JM. Antibiotic therapy in acute calculous cholecystitis. J Visc Surg 2013;150:3-8.  Back to cited text no. 24
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusions
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed566    
    Printed56    
    Emailed0    
    PDF Downloaded51    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]