BACTERIOLOGICAL PATTERNS AND ANTIBIOTIC SENSITIVITIES IN CALCULUS CHOLECYSTITIS
Abstractbiliary tract. There is an inherent difficulty in identifying patients having infected gall bladders who may have the risk of wound infection or gram negative septicaemia after cholecystectomy. This study was conducted to ascertain the bacteriological patterns and antibiotic sensitivities of bile in calculus cholecystitis patients presenting at a tertiary care hospital and formulate guidelines for prophylactic antibiotic therapy. Methods: This descriptive study was conducted in Combined Military Hospital, Rawalpindi from 20th Dec 2006 to 19th Sep 2008. A total number of 150 patients presenting at CMH Rawalpindi for elective cholecystectomy were included in the study. Prophylactic antibiotics were given after the induction of anaesthesia, 5 ml of bile was aspirated from their intact gall bladder was subjected to bacteriological examination at Armed Forces Institute of Pathology. A pro forma was designed to record all the information regarding isolated bacteria and their sensitivities to various antibiotics. Data was analyzed using SPSS-11. Results: Growth of bacteria was seen in 57 (38%) cases and no growth was seen in 93 (62%). Most common organism cultured was: Pseudomonas aeruginosa followed by Escherichia coli (E. Coli) and Klebsiella pneumoniae. The most effective antibiotic was Imipenem followed by Piperacillin- Tazobactum combination and Amikacin. Conclusions: Imipenem, Piperacillin-Tazobactum combination and Amikacin should be used for prophylaxis in cases of cholelithiasis undergoing elective cholecystectomy.Keywords: Cholecystectomy, bile culture, cholelithiasis, prophylactic antibiotics
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.
Patnaik GC; Panda BK; Sethy MK; Nayak B; Muduli IC; Panda C, et al. Study on aetiopathogenesis of gall stone disease with reference to chemical analysis and culture of gall stones. Antiseptic 2004;101:260–1.
Chang W T, Lee K T, Wang S R, Chuang S C, Kuo K K, Chen J S, et al. Bacteriology and Antimicrobial Susceptibility in Biliary Tract Disease: an Audit of 10-Year 's Experience. Kaohsiung J Med Sciences 2002;274:221–8.
Purtak J K, Kostewicz WJ, Mularczyk T. Ten years of experience with laparoscopic cholecystectomy. Wiad Lek 2007;60(5,6):231–4.
Boni L, Benevento A, Roveva F, Dionigi G, Di Gioseppe M, Bertoglio C, et al. Infective complications in laparoscopic surgery. Surg Infect 2006;2:109–11.
Gunn A.A. Antimicrobial prophylaxis in biliary surgery. World J Surg 1982;6:301–5.
Tocchi A, Lepre L, Costa G, Liotta G, Mazzoni G, Maggiolini F. The need for antibiotic prophylaxis in elective laparoscopic cholecystectomy. Arch Surg 2000;135:67–70.
Beardsley SL, Shlansky-Goldberg RD, Patel A, Freiman DB, Soulen MC, Stavropoulos SW, et al. Predicting infected bile among patients undergoing percutaneous cholecystostomy. Cardiovasc Intervent Radiol 2005;28:319–25.
Hazra P, Oahn KTH, Tewari M, Pandey AK, Kumar K, Mohapatra TM, et al. The frequency of live bacteria in gallstones. J Intl Hep Panc Biliary Assoc 2004;6:28–32.
Douglas M, Jon E. Anaerobes in human biliary tracts. J Clin Microbiol 1977;6:494–98.
Petakovic G, Korica M, Gavrilovics S. Bacteriologic examination of gallbladder contents. Med Pregl 2002;55(5,6):225–8.
Kuthe SA, Kaman L, Verma GR, Singh R. Evaluation of the role of prophylactic antibiotics in elective laparoscopic cholecystectomy: a prospective randomized trial. Trop Gastroenterol 2006;27(1):54–7.
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.
Koc M, Zulfikaroglu B, Kece C, Ozalp N. A prospective randomized study of prophylactic antibiotics in elective laparoscopic cholecystectomy. Surg Endosc 2004;18:565.
Higgins A, London J, Charland S, Ratzer E, Clark J, Haun W, et al. Prophylactic antibiotics for elective laparoscopic cholecystectomy. Arch Surg 1999;134:611–4.
Leeuwen PA, Keeman JN, Butzelaar RM, 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(6):179–82.
Pitt H A, Postier R G, Cameron J L. Biliary bacteria, significance and alterations after antibiotic therapy. Arch Surg 1982;117(4):445–9.
Colizza S, Rossi S, Picardi B, Carnuccio P, Pollicita S, Rodio F, et al. Surgical infections after laparoscopic cholecystectomy: ceftriaxone vs ceftazidime antibiotic prophylaxis. A prospective study. Chir Ital 2004;56(3):397–402.
Landau O, Kott I, Deutsch A A, Stelman E, Rafael R. Multifactorial analysis of septic bile and septic complications in biliary surgery. World J Surg 1992;16:962–4.
Gul YA, Hong LC, Prasannan S. Appropriate antibiotic administration in elective surgical procedures: still missing the message. Asian J Surg 2005;28:104–8.
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.
Maurer, KR, Everhart, JE, Ezzati, TM, Johannes, RS. Prevalence of gallstone disease in Hispanic populations in the United States. Gastroenterology 1989;96:487.
de Santis A, Capri R, Repice AM, Silvana M, Grepco Group. The natural history of gall stone: Thee Grepco experience. Hepatology 1995;21:656-60.
Barbara L, Sama C, Morselli-Labate AM, Danesi GL, Festi D, Mastroianni A, et al. A ten year incidence of gallstone disease: The Sirmione study. J Hepatol 1993;18:43.
Willett, WC, Dietz, WH, Colditz, GA. Guidelines for healthy weight. N Engl J Med 1999;341:427.
Scragg, RK, McMichael, AJ, Baghurst, PA. Diet, alcohol, and relative weight in gallstone disease: A case control study. Br Med J 1984;288:1113.
Amaral, JF, Thompson, WR. Gallbladder disease in the morbidly obese. Am J Surg 1985;149:551.
Csendes A, Burdiles P, Maluenda F, Diaz JC, Csendes P, Mitru N, et al. Simultaneous bacteriologic assessment of bile from gallbladder and common bile duct in control subjects and patients with gallstones and common duct stones. Arch Surg 1996;131:389.
Michail P O, Klonis G D, Haritopoulos N G, Golematis B G, Dreiling D A. Biliary Bacteriology Based on Intra-operative Bile Cultures. Am J Gastroenterol 2008;68:51–5.
Reiss R, Eliashiv A, Deutsch A. Septic Complications and Bile Cultures in 800 Consecutive Cholecystectomies. World J Surg 1982;6:195–9.
den Hoed PT, Boelhouwer RU, Veen HF, Hop WC, Bruining HA. Infections and bacteriological data after laparoscopic and open gallbladder surgery. J Hosp Infect 1998;39(1):27–37.
Lorenz R, Herrmann M, Kassem AM, Lehn N, Neuhaus H, Classen M. Microbiological examinations and in-vitro testing of different antibiotics in therapeutic endoscopy of the biliary system. Endoscopy 1998;30(8):708–12.
Lu Y, Xiang T H, Shi J S, Zhang B Y. Bile anaerobic bacteria detection and antibiotic susceptibility in patients with gallstone. HBPD Int 2003;2:431–4.