Abstract
Objectives: 1- To identify the bacteria from the gall bladder and stool samples taken during cholecystectomy of patients with acute, and chronic cholecystitis of calculus and acalculus types. 2To use serological agglutination tests for the diagnosis of typhoid and brucellosis cholecystitis.3- To find out the antibiogram of the isolated bacteria from the different cases. Methods: A prospective case series study was conducted at Al-Jumhori Teaching Hospital, and Ninevah and Al-Zahrawi Private Hospitals during the period from the 1 st of October 2003 to the 30 th of June 2004. A total of 150 patients undergoing cholecystectomy (134 females and 16 males)were studied. From each patient samples were collected from the gall bladder (bile, tissue biopsy and stone if present),blood for serological tests and stool (from 69/150 patients). Results: Among the gall bladder samples, 101/150 (67.3%) cases showed bacterial growth, the remaining 49 (32.7%) cases had no growth. The bacterial growth was seen among 83.3% and 64.3% of acute and chronic cholecystitis respectively. A single agent per sample was detected in 62.4% of the cases, whereas mixed growth was identified in the remaining 37.6%. The gram-negative bacteria were predominant and represented 86.7% of the isolates,while gram-positive ones were 13.3%. The most common aerobic bacteria isolated were E. coli (19.3%), while anaerobes were detected in only 5.3% of the isolates. The stool cultures showed similar microorganisms to those identified in the gall bladder samples in 74% of cases. In acute cholecyctitis all the gram-negative bacteria were sensitive to ciprofloxacin followed by ceftriaxone (96.5%) and gentamycin (96.5%). In chronic cholecystitis the most effective drug was ciprofloxacin (93.7%) followed by amikacin (82.2%). In both acute and chronic cholecystitis the least effective antibiotic was ampicillin.Typhoid cholecystitis was detected among four cases only, while brucellosis cholecystitis was not observed. Conclusions: The bacteria causing acute and chronic types of cholecystitis are similar and predominantly are gram-negative bacilli. The intestinal origin of these microorganisms suggests ascending infection from the intestine to the biliary tract. Ciprofloxacin is the most effective drug against the isolated bacteria.
Highlights
1- To identify the bacteria from the gall bladder and stool samples taken during cholecystectomy of patients with acute, and chronic cholecystitis of calculus and acalculus types. 2To use serological agglutination tests for the diagnosis of typhoid and brucellosis cholecystitis.3- To find out the antibiogram of the isolated bacteria from the different cases
Enteric bacteria can be cultured from gall bladder bile in approximately half of patients with acute cholecystitis, but bacteria are not thought to contribute to the actual onset of acute cholecystitis
The pathogenesis is related to acute inflammation of the gall bladder, which often begins aseptically and complicated by a secondary infection with gas forming bacilli. These may reach the gall bladder by the Chronic cholecystitis is a chronic inflammation of the gall bladder and is generally associated with cholelithiasis with fibrosis of its wall
Summary
1- To identify the bacteria from the gall bladder and stool samples taken during cholecystectomy of patients with acute, and chronic cholecystitis of calculus and acalculus types. 2To use serological agglutination tests for the diagnosis of typhoid and brucellosis cholecystitis.3- To find out the antibiogram of the isolated bacteria from the different cases. 1- To identify the bacteria from the gall bladder and stool samples taken during cholecystectomy of patients with acute, and chronic cholecystitis of calculus and acalculus types. Emphysematous cholecystitis is a rare form of acute cholecystitis It is usually of gangrenous type and caused by gas-forming microorganisms[2].Emphysematous cholecystitis is characterized by the presence of gas in the gall bladder, and is more common in males than females[3]. The pathogenesis is related to acute inflammation of the gall bladder, which often begins aseptically and complicated by a secondary infection with gas forming bacilli These may reach the gall bladder by the Chronic cholecystitis is a chronic inflammation of the gall bladder and is generally associated with cholelithiasis with fibrosis of its wall. Cholecystitis is the most common intraabdominal localized infection due to Salmonella[4]
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