Bacteriological profile of patients with biliary obstruction in tertiary care center

Neelakanth U. Parappanavar; Sumit Kumar Suman; Sai Krishna Katepally; P. Shravan Kumar; Prafulla Kumar Singh

doi:10.18203/2320-6012.ijrms20233037

Authors

Neelakanth U. Parappanavar Department of Medical Gastroenterology, Gandhi Medical College, Secunderabad, Telangana, India
Sumit Kumar Suman Department of Medical Gastroenterology, Gandhi Medical College, Secunderabad, Telangana, India
Sai Krishna Katepally Department of Medical Gastroenterology, Gandhi Medical College, Secunderabad, Telangana, India
P. Shravan Kumar Department of Medical Gastroenterology, Gandhi Medical College, Secunderabad, Telangana, India
Prafulla Kumar Singh Department of Medical Gastroenterology, Gandhi Medical College, Secunderabad, Telangana, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20233037

Keywords:

Bacterobilia, Biliary obstruction, Cholangitis, ERCP, Sensitivity

Abstract

Background: Bile ducts are usually kept sterile by bacteriostatic and flushing effects of bile. Patients presenting with biliary obstruction especially due to benign etiology have either single or multiple bacterial organisms. Acute cholangitis carries significant morbidity with variable mortality rate. The serious presentation of such toxic patients signifies the requirement of appropriate antibiotic treatment. Choledocholithiasis followed by neoplasm and benign biliary strictures are the common predisposing factors for obstruction. Widespread use of antibiotics over years lead to change in sensitivity pattern of organisms which necessitates change in empiric antibiotic usage.

Methods: This retrospective study was conducted in department of medical gastroenterology. We studied 50 patients with biliary obstruction (clinical and demographic data were recorded). The diagnosis of cholangitis was made according to TG2018. While undergoing therapeutic ERCP, bile aspirate was collected by biliary cannulation and sent for microbiological analysis. The antibiotic susceptibility pattern and rest of the data were analyzed by appropriate statistical tests.

Results: Mean age of the study group was 49 years. Majority were female in study (60%). Overall, 74% had benign etiology, 32% had cholangitis. Bile cultures were positive in 64% patients 75% of them had benign etiology (gallstone being most common; 56%) and 25% had malignant etiology. Bacterobilia in cholangitis patients was statistically significant in comparison to patients without cholangitis (p-0.01). Organisms grown are mainly aerobic gram negative, most common being E. coli, Klebsiella and Pseudomonas species. Patients having bacterobilia had mortality of 6.25% during hospital stay.

Conclusions: In this study we found higher sensitivity to colistin (90.6%), tigecycline (81.25%), amikacin (75%) and least sensitivity was noted for ampicillin (6.25%) followed by cefixime (12.5%). Sensitivity to previously commonly used ciprofloxacin antibiotic was 31.25%. Study confirms the significance of obtaining routine bile sample during ERCP in obstructed biliary system to prevent dreaded complications of cholangitis.

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References

Yusoff I, Barkun J, Barkun A. Diagnosis and management of cholecystitis and cholangitis. Gastroenterol Clin North Am. 2003;32:1145-68.

Lai EC, Mok FP, Tan ES, Lo CM, Fan ST, You KT, et al. Endoscopic biliary drainage for severe acute cholangitis. N Engl J Med. 1992;326:1582-6.

Rerknimitr R, Fogel EL, Kalayci C, Esber E, Lehman GA, Sherman S. Microbiology of bile in patients with cholangitis or cholestasis with and without plastic biliary endoprosthesis. Gastroint Endosc. 2002;56:885-9.

David Q, Wang H, Nezam H. 2020, Gallstone Disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. Elsevier, Philadelphia; 2020:1045.

Tanaka A, Takada T, Kawarada Y, Nimura Y, Yoshida M, Miura F, et al. Antimicrobial therapy for acute cholangitis: Tokyo Guidelines. J Hepatobil Pancreat Surg. 2007;14:59-67.

Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis. J Hepatobil Pancreat Sci. 2018;25(1):17-30.

Sahu MK, Chacko A, Dutta AK, Prakash JA. Microbial profile and antibiotic sensitivity pattern in acute bacterial cholangitis. Indian J Gastroenterol. 2011;30(5):204-8.

Raghhupatruni P, Gopalakrishna R, Ankarath V, Sadasivan S. Profile and outcome of patients with acute cholangitis in a tertiary center in south India. Soc Gastroint Endosc India. 2021;12(3):127-32.

Noor MT, Goyal V, Vasepalli P, Jain M, Thakur BS, Gorie N. Bacterial isolates and antibiotic sensitivity pattern in choledochal bile collected during ERCP: a report from central India. Indian J Res. 2021;10(5):13-5.

Goo JC, Seong MH, Shim YK, Lee HS, Han JH, Shin KS, et al. Extended spectrum-β-lactamase or carbapenemase producing bacteria isolated from patients with acute cholangitis. Clin Endosc. 2012;45(2):155-60.

Lee CC, Chang IJ, Lai YC, Chen SY, Chen SC. Epidemiology and prognostic determinants of patients with bacteremic cholecystitis or cholangitis. Am J Gastroenterol. 2007;102(3):563-9.

Ruan HQ, Liao GL, Peng P, Liu SQ, Wu CL, Qin JF, et al. Microbial profiles and risk factors of preexisting biliary infection in patients with therapeutic endoscopy. Gastroenterol Res Pract. 2019;2019.

Salvador VB, Lozada MC, Consunji RJ. Microbiology and antibiotic susceptibility of organisms in bile cultures from patients with and without cholangitis at an Asian academic medical center. Surg Infect. 2011;12:105-11.

Shenoy SM, Shenoy S, Gopal S, Tantry BV, Baliga S, Jain A. Clinicomicrobiological analysis of patients with cholangitis. Indian J Med Microbiol. 2014;32(2):157-60.

Tanaka A, Takada T, Kawarada Y, Nimura Y, Yoshida M, Miura F, et al. Antimicrobial therapy for acute cholangitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14:59-67.

Shivaprakasha S, Harish R, Dinesh KR, Karim PM. Aerobic bacterial isolates from choledochal bile at a tertiary hospital. Indian J Pathol Microbiol. 2006;49:464-7.