Infection of the biliary tract in patients with gallstones

Abstract

Infection is one of the serious complications of operation on the biliary tract, and such infection may be fatal. The objective of this study is to review the microflora of the biliary tract of patients with gallstones, to examine the relationship between infection in bile and post-operative septic complications, and to provide a rational approach to the usage of antibiotics. Twenty-four consecutive cases of open cholecystectomy done at Hospital Universiti Sains Malaysia over two years were taken into the study. Specimens of bile from the common bile duct and gallbladder, and specimens of gallbladder wall and gallstones were sent for culture for both aerobic and anaerobic organisms. Eight patients had Cefuroxime as prophylaxis, eleven had therapeutic antibiotics, and five received no antibiotics at all. The result indicated that 12 cases (50%) were culture-negative and 8 were positive for Klebsiella sp (33%). E. coli were positive in 6 cases (25%). Salmonella typhi was isolated in one case only. No anaerobic organisms were cultured. One case had post-operative complication in the form of wound infection which cultured the same organism as the bile, namely Pseudomonas aeruginosa. In conclusion, the main microflora of the biliary tract of patients with gallstones are Klebsiella sp and E.coli. Presence of bacteria in bile does not seen to be related to occurrence of post-operative infection. Prophylaxis or no prophylaxis at all in non-jaundiced patients does not seem to make a difference as far as postoperative complication in concerned.