Frequency of Biliary Infection and Antimicrobial Susceptibility Pattern in Patients with Extra-Hepatic Biliary Obstruction Undergoing Non-Surgical Interventions with Reused Accessories

Abstract

1.1.Introduction: Data of the frequency of biliary infection in patients of obstructive jaundice, the microbial spectrum and antibiotic sensitivity from Asia is scant. We undertook a prospective study to evaluate the frequency and nature of biliary infection in patients with obstructive jaundice. 1.2.Material and methods:Bile samples collected from patients undergoing biliary drainage for Extra Hepatic Biliary Obstruction (EHBO) were cultured by standard microbiological methods and sensitivity to common antibiotics assessed as per National Committee for Clinical Laboratory Standards (NCCLS) guidelines. 1.3.Results and discussion: Of the total 301 EHBO patients presenting to hospital and included in study prospectively, 154 were male, 147 were female. N= 208 patients underwent Endoscopic Retrograde Cholangio Pancreatography (ERCP), 93 patients underwent Percutaneous Transhepatic Biliary Drainage (PTBD). Total 212 (70%) of the patients had clinical cholangitis. Bacteria were isolated in 396 (78%) of the 505 bile samples. Bacteribilia was found more often in benign EHBO (85%) than in malignant (73%, p=0.001), in patients with cholangitis (91%) than without cholangitis (58%, P<0.00001) and in those with post procedure status (94%) than naive (60%, p<0.00001). Poly microbial cultures obtained in 189(50%) of positive samples were more common in cholangitis (47%) than non cholangitis group (19%, p<0.00001) and in post biliary procedure status (49%) than in naive (43%, P=0.0005). Gram-negative bacilli were isolated in 485(83%) (Escherichia coli 50%, Pseudomonas 25%, Citrobacter 7%, Klebsiella 7.4%, Proteus 5.6%) and Gram positive cocci in 17 % (Enterococcus 83%). Gram negative bacilli were sensitive to Carbapenems, Amikacin and Piperacillin-tazobactam but show a high frequency of resistance to 3rd generation cephalosporins and quinolones. Gram positive cocci were more sensitive to Vancomycin, Teicoplanin and Amoxicillin. 1.4.Conclusion:Bacteribilia is seen in 78% of bile samples, bacteribilia is more common in those with clinical cholangitis, benign etiology and a history of previous biliary procedure. Poly microbial culture positivity is more common in those with cholangitis and post procedure status. Gram negative bacteria showed high frequency of resistance to 3rd generation cephalosporins and quinolones.