Bacteriological study of bile in patients with cholangitis due to biliary tract obstruction

Abstract

Acute cholangitis is a serious complication secondary to obstruction of the extrahepatic biliary tract, due mainly to common bile duct stones, but also to malignant tumoral obstruction. The prevalence of bacterial species in the bile of patients with cholangitis have been reported widely. And there was no avalable study in bacteriologic features of bile during past 10 years in Korea. In recent years, increased attention has been focused on the Enterococcus due to increasing in incidence of nosocomial infection and resistance to broad range of antimicrnbial agents of this organism. The purpose of this study wa s to analyse the bacteriologic features of bile in patients with cholangitis. Bacteriological examination w a s made of bile from 356 patients with cholangitis due to biliary tract obstruction, 105 of them with common bile duct stone and 251 of them with malignant disease. Bile specimens were taken during percutaneous transhepatic biliary drainage or endoscopic nasobiliary drainage. The specimens were cultured aerobically and anaerobically and then the antibiotic s~nsitivity test was done. The overall positive culture rates was 81.4%. There was significant difference in positive culture rates between the patients with common bile duct stone and the patients with malignant disease. ( 88.5% vs 78.4%, p<0.05 ) But there was no significant difference in bacteriological features between the patients with common bile duct stone and the patients with malignant disease. The commonly isolated organisms were Enterncoccus ( 21.6% ), E.coli (19.7%), and Klebsiella ( 17.2% ) respectively. The isolation rate of anaerobes were only 2%. The rate of polymicrobial infection was 78.1%. The rate of ampicillin-resistant Enterococcus was 35%. The rate of gentamicin-resistant Enterococcus was 28%. The rates of 3rd generation cephalosporins-resistant Klebsiella were over 30%. This study shows that 1) many microorganisms have resistance to a broad range of antimicrobial agents, and 2) the antibiotic coverage against Enterococcus should be considered for the treatment of cholangitis due to the increasing tendency to Enterococcus infection.