Bacteriological examination of gallbladder contents

Abstract

Introduction Acute calculous (obstructive) cholecystitis develops as a consequence of cystic obstruction and obstruction of bile flow into choledochus. Most often it is a result of impacted gallstones in Hartman's pouch or the cystic duct. Their direct pressure on gallbladder mucosa causes ischemia, necrosis and ulceration with consequential wall edema and obstructed venous flow. This mechanism is further increasing and spreading the inflammatory process. Ulcerations may be that extensive, that mucosa is highly recognizable on the microscopic preparation. Leukocyte infiltration of all segments occurs. Results of necrosis are as follows: perforation with pericholecystic abscess formation, fistulization or biliary peritonitis. Aim The aim of this investigation was to use microbial sensitivity tests in order to establish possibilities of antibiotic therapy in patients with acute cholecystitis. Material and methods Using random sampling a total of 240 patients with acute cholecystitis were included in the investigation. They were all treated at the Clinic of Abdominal and Endocrine Surgery of the Clinical Center Novi Sad in the period 1997-1999. All patients underwent bacteriological examination and were coherent in regard to sex and age. Microbial sensitivity tests analyzed two groups of bacteria: Group I Escherichia coli, Klebsiella and Staphylococcus and Group II: other isolated bacteria (Citrobacter, Enterobacter, Enterococcus, Proteus, Pseudomonas Serratia and Streptococcus). Results In our material Escherichia coli was isolated in most patients - 32 (55.17%), Klebsiella and Staphylococcus in 6 (10.34%) patients and Streptococcus in 4 (6.90%), whereas other bacteria were infrequent (Citrobacter and Serratia in 3.45%, Enterobacter, Proteus and Pseudomonas in 1.75%). Thus, E. coli, Klebsiella and Staphylococcus were established in 75.85% of bacteriologic findings, and all the rest in 24.15%. Assessment regarding premedication with antibiotics started with an assumption that cholecystitis was caused by one of the bacteria isolated in 75% of cases. That is why antibiotics should be given prior to surgery primarily those to which these bacteria are susceptible in more than 95% of cases. Conclusions E. coli, Klebsiella and Staphylococcus participate with 75.85% of all bacteriologic findings, whereas all the others make 24.15% Amikacin, Cefalexin, Ceftriaxone, Ofloxacin and Pefloxacin are recommended in premedication; considering the fact that new generation antibiotics have not been tested yet, they were not taken into consideration for this study.