Portrait of Microbiology Profile in Obstructive Jaundice Cases: A Single Center Experience

Abstract

Introduction: Physiologically bile is aseptic, however bacteria may be present in bile in cases of biliary infections. Portrait of biliary microbiology in patients with obstructive jaundice in Indonesia have never been reported before. Methods: Data of obstructive jaundice patients in digestive surgery division, Fatmawati General Hospital were collected prospectively from November 2020 to June 2021. Data collected included age and gender, diagnosis, causes of jaundice, preoperative total and direct bilirubin, preoperative leucocyte and culture results. Bile was aspirated, using a 3cc syringe, directly from the biliary tree above the obstruction and placed into amies transport medium and sent to microbiology laboratory. Results: Bile samples were obtained in 28 out of 39 cases of obstructive jaundice. All samples were obtained during an open surgical procedure without prior intervention. There was equal distribution between male and female female patients with the mean age of 51.8 (± 12.7). The cause of obstructive jaundice were 57% biliary stones and 39% of malignant causes. Positive culture was found in 25% of cases (n=7), the most common pathogen found was Escherichia coli (57%). Fungal infection, candida tropicalis, was found in one case (14%). Conclusion: Although bile is essentially sterile, pathogens can grow in selected cases. The frequency and spectrum of bacteria that infect bile, including their sensitivity to antibiotics are important in guiding patient management. This is a preliminary result from an ongoing study in our centre to determine the best choice of antibiotics given to obstructive jaundice patients.