Bacteriological profile of bile in cholecystectomy patients in tertiary care center

Sunil Kaval; Swati Tewari

doi:10.4103/wjsi.wjsi_9_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 1 | Issue : 1 | Page : 3-6

Bacteriological profile of bile in cholecystectomy patients in tertiary care center

Sunil Kaval¹, Swati Tewari²
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 Submission	28-Apr-2022
Date of Decision	10-May-2022
Date of Acceptance	12-May-2022
Date of Web Publication	17-Jun-2022

Correspondence Address:
Sunil Kaval
Lala Lajpar Rai Memorial Medical College, Meerut - 250 004, Uttar Pradesh
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/wjsi.wjsi_9_22

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

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

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

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Results

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

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Figure 2: Sex distribution

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Figure 3: Distribution of surgical treatment procedure

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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

%), followed by Klebsiella spp. 17 (25%), 4 (6%) Pseudomonas spp., 2 (3%) Salmonella ^{More Details} spp., and Staphylococcus aureus

and Acinetobacter 1 (1.4%) each. The remaining bile samples 58 (46%) were sterile [Figure 4].

Figure 4: Bacteriological profile of bile

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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

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Discussion

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

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.

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