Antibiotic Resistance pattern in Bile from Cholecystectomised Patients by Multiplex PCR

Abstract

SummaryBackgroundBile in the biliary tract is normally sterile. Presence of gallstones, ascending infection from duodenum or bacterial translocation from portal vein leads to microfloral colonization in biliary system.AimThis study was aimed to evaluate the microbiological profile of bile from gall bladder for determination of the appropriate antibiotics in cholecystectomised patients.MethodsThis cross sectional study included patients who underwent laparoscopic or open cholecystectomy in Dhaka Medical College Hospital, Dhaka, from July, 2013 to December, 2014. Total 246 intraoperative bile were cultured aerobically in Blood agar and MacConkey’s agar media. The identified isolates were tested for their sensitivity pattern according to CLSI guidelines and multiplex PCR was used to detect virulence genes ofSalmonellaTyphi and anaerobic bacteria along with drug resistance genes.FindingsOut of 246 bile samples, organisms were identified in 171 (69.51%) cases; 119 (48.37%) were aerobic bacteria identified by culture and PCR and 52 (21.14%) were anaerobic bacteria identified by multiplex PCR.Escherichia coli(26.61%) were found predominantly followed byStaphylococcus aureus(19.35%),Clostridium perfringens(13.82%).Salmonella entericaserovar Typhi was detected by culture and PCR in 3 (1.22%) and 8 (3.45%) samples respectively. Prevalence of ESBLs, Carbapenemase producers and MRSA were detected phenotypically in 10.96%, 16.44% and 8.33% samples respectively and the resistance genes blaCTX-M-15 (50.0%), blaOXA-1-group (25.0%), blaNDM-1 (62.50%), OXA-181/OXA-84 (12.5%) and mecA (8.33%) were detected.ConclusionSignificant proportion of aerobic and anaerobic bacterial infection associated with biliary tract obstruction may warrants serious health risk to cholecystectomised patients in this region.