Prevalence of bacteriobilia in patients undergoing elective colecystectomy / Prevalência de bacteriobilia em pacientes submetidos à colecistectomia eletiva

ABSTRACT Background: Cholelithiasis is one of the diseases with greater surgical indication. Currently, laparoscopic cholecystectomy is the gold standard in the treatment of cholelithiasis. Aim: To analyze the culture of bile from patients with cholelithiasis, mainly in the occurrence of brown and mixed stones. Methods: Was carried out a prospective study with 246 cases with biliary lithiasis who underwent elective laparoscopic cholecystectomy. Bile culture was performed in all. During anesthetic induction the patients received a single dose of intravenous cefazolin 1 g. At the end of the surgery, the gallbladder was punctured, its contents extracted and immediately placed in a sterile 20 ml propylene flask and promptly sent to bacterioscopy with Maconkey and blood agars. Incubation at 37° C for 24 h was carried out. A protocol was elaborated to include the main factors potentially related to cholelithiasis and the possible presence of associated bacterial infection. Results: Of the 246 patients, 201 had negative bile culture and 45 positive. Of the 45 patients with bacteriobilia, 34 had growth of a single type of bacterium in bile culture and 11 more than one. Conclusions: It was observed a relationship between bacteriobilia and age, suggesting that age is a risk factor for bacteriobilia. The use of antibiotic prophylaxis in the elderly is therefore recommended.

RESUMO Racional: A colecistolitíase é uma das doenças que têm maior indicação cirúrgica. Atualmente a colecistectomia laparoscópica é o padrão-ouro no seu tratamento. Objetivo: Analisar a cultura da bile de pacientes portadores de colecistolitíase, principalmente na ocorrência de cálculos com pigmentos marrons e mistos. Métodos: Foi realizado estudo prospectivo de 246 casos de pacientes portadores de litíase biliar, submetidos à colecistectomia laparoscópica eletiva, sendo realizada cultura da bile. Durante a indução anestésica os pacientes receberam dose única de cefazolina 1 g, intravenosa. No final da operação foi puncionada a vesícula biliar, extraído seu conteúdo e imediata colocação em frasco estéril de propileno de 20 ml e prontamente encaminhado para bacterioscopia com semeadura do material coletado em ágar sangue e de Maconkey com posterior incubação em estufa de cultura a 37° C durante 24 h. Foi elaborado um protocolo capaz de englobar os principais fatores potencialmente relacionados à colecistolitíase e a possível presença de infecção bacteriana associada. Resultados: Dos 246 participantes, 201 tiveram cultura de bile negativa e 45 positiva. Dos 45 pacientes com bacteriobilia, 34 tiveram crescimento de um único tipo de bactéria e 11 mais de uma. Conclusões: Foi observada relação entre bacteriobilia e a idade, sugerindo que a idade é fator de risco para bacteriobilia. Recomenda-se assim o emprego de antibioticoprofilaxia nos idosos.

Microflora of bile aspirates in patients with acute cholecystitis With or without cholelithiasis: a tropical experience

The current study determined the spectrum of biliary microflora with special emphasis on enteric fever organisms in patients with acute cholangitis with and without cholelithiasis or other biliary diseases. The patients were divided into three groups: Group A consisted of patients with acute cholecystitis with cholelithiasis; Group B consisted of patients with acute cholecystitis with gastrointestinal ailments requiring biliary drainage and group C consisted of patients with gallbladder carcinoma. Gallbladder, bile and gallstones were subjected to complete microbiological and histopathological examination. Antimicrobial susceptibility of the isolates was performed as per CLSI guidelines. Bacteria were recovered from 17 samples (32 percent) in Group A, 17 (51.4 percent) in Group B and 1 (1.6 percent) in Group C. The most common organisms isolated were Escherichia coli (11, 29.7 percent), Klebsiella pneumoniae (10, 27 percent), Citrobacter freundii (3, 8.1 percent), Salmonella enterica serovar Typhi (3, 8.1 percent), etc. The majority of Enterobacteriaceae isolates were susceptible to piperacillin-tazobactam and meropenem. As regards Salmonella spp., S. Typhi was isolated from 2 (3.8 percent) patients in Group A and 1 (16 percent) in Group C. Antimicrobial susceptibility of potential causative organisms, the severity of the cholecystitis, and the local susceptibility pattern must be taken into consideration when prescribing drugs. A protocol regarding the management of such cases should be formulated based on observations of similar studies.

Detection of Helicobacter DNA in bile from bile duct diseases

Several species of Helicobacter colonize the hepatobiliary tract of animals and cause hepatobiliary diseases. The aim of this study is to investigate Helicobacter found in the biliary tract diseases of humans. Thirty-two bile samples (15 from bile duct cancer, 6 from pancreatic head cancer, and 11 from intrahepatic duct stone) were obtained by percutaneous transhepatic biliary drainage. Polymerase chain reaction analysis using Helicobacter specific urease A gene and 16S rRNA primers, bile pH measurement, and Helicobacter culture were performed. Helicobacter DNA was detected in 37.5%, and 31.3% by PCR with ureA gene, and 16S rRNA, respectively. The bile pH was not related to the presence of Helicobacter. The cultures were not successful. In conclusion, Helicobacter can be detected in the bile of patients with bile duct diseases. The possibility of pathogenesis of biliary tract diseases in humans by these organisms will be further investigated.

Detection del Helicobacter pylori por reacción en cadena de la polimerasa en muestras de bilis de pacientes con litiasis vesicular y coledociana / Detection of Helicobacter pylori by polimerase reaction in bile samples from gallblader and bile stones

Algunos trabajos describen la presencia de H. Pylori en muestras de bilis obtenidas durante la cirurgía por litiasis en vesícula y vías biliares. El objetivo de este trabajo, ha sido detectar la presencia del ADN del H. Pylori por medio de la Reacción en cadena de la Polimerasa (PCR) en muestras de bilis de pacientes con litasis vesicular y/o de vías biliares. Las muestras de bilis fueron obtenidas de 26 pacientes, 19 con litiasis vesicular y 7 con litiasis vesicular y coledociana, con edades comprendidas entre 22 a 69 años, media de 49,6 años, por punción de vesicular durante la colecistectomia. Las muestras fueron tratadas adecuadamente y preparadas para su investigación por PCR. 2 de 26 casos (7,6 por ciento) fueron positivos para la presencia en bilis del DNA del H. Pylori. Nuestro trabajo sugiere que el DNA del H P puede ser encontrado en muestras de bilis de pacientes portadores de litiasis biliar en la Argentina.

Actinomycotic cholecystitis.

Actinomycotic cholecystitis is rare. We report a 65-year-old woman who was admitted with repeated attacks of pain in the abdomen and vomiting. Clinical and laboratory findings suggested the diagnosis of cholecystitis with cholelithiasis. At cholecystectomy the gall bladder was inflamed with a small perforation, and contained many calculi. Gram's staining of the gall bladder wall revealed Gram-positive actinomycotic colonies.

Participacion bacteriana en estructura y composicion de cálculos biliares / Bacterial participation in the structure and composition of the gallstones

Se estudió el comportamiento de cálculos biliares en líquidos de diferente densidad incluyendo bilis hepática y bilis vesicular. Curiosamente cálculos de características similares en forma, volumen, peso y densidad tienen diferente localización porque alguns flotan en la superficie y otros se introducen hasta el fondo de las soluciones. Ello, debido a que en su estructura interna se encontraron espacios vacíos únicos o múltiples y pueden clasificarse como "cálculos flotadores" o "ballon calculli" . Estos espacios estarían ocupados por gases de origen bacteriano que fueron atrapados durante los processos de cristalización y estructuración de cálculos. Desde el punto de vista químico se relevó que en su composición existe lisolectina, cuya presencia se explica por actividad enzimática de fosfolipasa de origen bacteriano.

Clinical and bacteriological assessment in cholelithiasis

In a prospective study of 195 patients who underwent cholecystectomy, 184 [94.4%] cases had bile bacteriological studies. Positive cultures were found in 36 [19.6%] patients. E. Coli, Streptococcal strains, Klebsiella and Enterobactor were the commonest organisms isolated. The highest incidence of positive bile was in those patients who were over 60 years old [36.4%], those who had bilio-enteric fistulae [100%], acute cholecystitis [60%], and choledocholithiasis [50%]. Diabetic patients had a 28.6% incidence rate. Prophylactic antibiotics were given selectively to 39 [21.2%] high-risk patients. wound infection developed in 15 [8.2%] patients. Ten of these had positive bile, making up 27.8% of the total cases who had positive cultures. The other 5 cases had sterile bile, making up 3.4% of the total cases who had sterile bile. In the first group, wound and bile bacteria were the same in all cases except in one [90%] It was concluded that in patients with cholelithiasis, prophylactic antibiotics can be restricted to the high-risk group