Int.J.Curr.Microbiol.App.

Sci (2020) 9(6): 156-160

International Journal of Current Microbiology and Applied Sciences

ISSN: 2319-7706 Volume 9 Number 6 (2020)
Journal homepage: http://www.ijcmas.com

Original Research Article https://doi.org/10.20546/ijcmas.2020.906.020

Bacteriological Profile of Bile in Cholecystectomy

Patients at Rims, Ranchi, India

Md Khalid Anjum1*, Amber Prasad1, Makbul Ansari2,

Manoj Kumar1 and Kumari Seema1

1
Department of Microbiology, 2Department of Surgery, Rajendra Institute of
Medical Sciences (RIMS), Ranchi, Jharkhand, India

*Corresponding author

ABSTRACT

To study the Bacteriological profile of bile of the patients undergoing Cholecystectomy

and their antibiogram. This prospective study was carried out in the Department of
Microbiology at Rajendra Institute of Medical Sciences, Ranchi between 1st March, 2018
Keywords to 31st July, 2018, of patients belonging to age group ranging from seven years to seventy
five years, undergoing cholecystectomy for cholelithiasis. The collected Bile samples were
Antibiogram cultured and bacteria were isolated. These were identified and antibiogram was done for
cholelithiasis all isolates. Total 64 patients (12 males, 52 females) were included in this study.
Klebsiella 11(17.19%) patients showed positive bile culture, in which Escherichia coli{n=04
pneumoniae (36.36%)} was the most common isolate followed by Klebsiella pneumoniae {n=03
Article Info (27.27%)}. Other organisms isolated were Pseudomonas aeruginosa, Staphylococcus
aureus, Enterococcus spp. and CoNS. The remaining bile samples were sterile {n=53}.
Accepted: Out of 64 patients, 27 (42.19%) underwent open laparotomy and the remaining 37
14 May 2020 laparoscopically. Most patients were of 51-60 years age group {n=22 (34.34%)} followed
Available Online: by 31-40 years {n=13 (20.31%)}. On antibiogram, E.coli (75%) and K. pneumoniae
10 June 2020
(66.6%) were sensitive to piperacillin/tazobactam and amikacin. P. aeruginosa showed
sensitivity to piperacillin/tazobactam & ceftazidime. Staphylococcus aureus (MRSA) was
sensitive to vancomycin and linezolid.

Introduction colonization of bile occurs, when there is gall

stone in gall bladder or in biliary tree. In some
Cholecystectomy is an operation that is cases, previous biliary intervention may also
frequently done in recent time, and is predispose to the bacterial infection without
commonly performed for gall bladder stone. gall bladder stone.
Generally bile remains in sterile condition,
because the daily excretion of bile causes Upon bile duct obstruction bacteria grow in
flush out the microorganism entering the stagnant bile and sometimes enter into
biliary tract in healthy persons. Bacterial systemic circulation causing sepsis or multi

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organ dysfunction syndrome. Hence it is cholelithiasis.

important to know the microbiological profile
of gallbladder before prophylactic treatment The patients were admitted a night before
given. surgery in the Department of Surgery and
were examined and investigated by concerned
The incidence of gallstone disease has a surgical team and anaesthetic team for fitness
marked rise in western countries during the for surgery. Consent was taken from the
past century. In the USA, UK, and Australia patient or patient’s attendant after explaining
the prevalence rate ranges between 15 to the nature of procedure such as open or
25%. In India it more common in North than laparoscopic, and even potential for
South and in East than West 1-3. Incidence of conversion from laparoscopic approach to
gallstone also increases with age and is more open cholecystectomy. All the patients were
in female than male (M:F =1:4). About half of given one dose of IV injection of Ceftriaxone
the gallstone patients are asymptomatic and 1gram at induction of anaesthesia and 2 doses
among them 1 -2 % requires cholecystectomy of the same were given postoperatively.
every year 4,5 .
The abdomens were examined and findings
Gram negative enteric aerobes such as were noted. Bile was aspirated from the
Escherichia coli, Klebsiella species and gallbladder of the patients undergoing open
Proteus species are commonly isolated, while cholecystectomy using a sterile syringe (5
Pseudomonas aeruginosa, Enterococcus ml), but in case of laparoscopic
faecalis, Bacteroides fragilis etc. are less cholecystectomy, bile was collected from the
commonly found. Prophylactic antibiotics excised gallbladder. The bile was collected in
therapy would be appropriate according to a sterile container and after proper labeling, it
organisms isolated from bile and hence it was transferred to Department of
could prevent postoperative infections. Microbiology, RIMS, Ranchi immediately. In
Prophylactic treatment does not sterilize bile, the microbiology laboratory the bile sample
but prevent infections. The postoperative was inoculated on the basal media such as
infection rate is less when prophylaxis has nutrient agar, MacConkey agar, and blood
been given, even when rates of bactibilia are agar, and incubated aerobically at 37°C
similar in treated patients and untreated temperature for 24- 48 h for the growth of
individuals. organisms. The bile was sterile when there
was no growth even after 48 hours of
The main objectives include to study the incubation. All positive culture were
bacteriological profile of bile of the patients identified by their colony morphology on the
undergoing Cholecystectomy. And also to plate, microscopic examination of Gram’s
determine antibiogram of isolated organisms. staining and appropriate biochemical
reactions. Antimicrobial susceptibility testing
Materials and Methods was performed on Mueller Hinton agar plates
using disc diffusion method according to
This prospective study was carried out in the Clinical and Laboratory Standard Institute
Department of Microbiology at Rajendra (CLSI) Guidelines.
Institute of Medical Sciences (RIMS), Ranchi,
Jharkhand, India, between 1st March, 2018 to Results and Discussion
31st July, 2018, of patients belonging to age
group ranging from seven years to seventy Total 64 patients 12 (18.75%) male and 52
five years, undergoing cholecystectomy for (81.75%) females were included in this study.
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In which maximum number of patients 22 Bile in the gallbladder is normally sterile in

(34.37%) were in the age group 51-60 years absence of gallstone or any pathology of
followed by 13 (20.31%) in age group 31- 40 biliary tract because of various anatomical
years. Out of 64 patients, 27 (42.19%) and physiological mechanisms such as a
underwent open laparotomy and the competent sphincter of Oddi prevents from
remaining 37 laparoscopically. intestinal contents refluxing into the bile duct,
and anterograde bile flow flushes the biliary
Out of 64 bile samples received for system periodically, keeping it free of
microbiological analysis, only 11(17.19%) organisms. In addition to it bile salts and
were culture positive. Escherichia coli {n=04 immunoglobulin A (IgA) in bile as it's
(36.36%)} was the most common isolate component have antibacterial activity to
followed by Klebsiella pneumoniae {n=03 protect the biliary tree from bacteria.
(27.27%)}. Other organisms isolated were Obstruction to bile duct for prolonged period
Pseudomonas aeruginosa {n=01(9.09%)}, leads to impaired intestinal wall barrier
Staphylococcus aureus {n=01(9.09%)}, function, causing bacteria to colonize bile
Enterococcus spp {n=01(9.09%)} and easier, thus E. coli is the most common
CoNS{n=01(9.09%)}. The remaining bile bacterium in development of bile infection.
samples were sterile {n=53 (82.81%)}. The enteric gram negative aerobes are
commonest organisms to be found in infected
On antibiogram, Escherichia coli showed bile. In our study, the most common
maximum sensitivity to Pipracillin/ organism isolated were Escherichia coli
Tazobactum, and Amikacin in 3 (75%) cases (36.36%) followed by Klebsiella pneumoniae
followed by Gentamicin and imipenem in 2 (27.27%). Similar results were seen in
(50%) cases. Klebsiella pneumoniae showed Sharma K et al., 11 and Parekh PM et al., 12.
maximum sensitivity to Pipracillin/
Tazobactum, and Amikacin in 2(66.66%) In our study, on culture and sensitivity test,
cases. Pseudomonas aeruginosa showed Escherichia coli showed maximum sensitivity
sensitivity to piperacillin/tazobactam & to Pipracillin/Tazobactum, and Amikacin in 3
ceftazidime. Among gram positive isolates (75%) cases followed by Gentamicin and
Staphylococcus aureus (MRSA) was sensitive imipenem in 2 (50%) cases. Klebsiella
to vancomycin and linezolid and pneumoniae showed maximum sensitivity to
Enterococcus spp. was sensitive to Pipracillin/Tazobactum, and Amikacin in
piperacillin/tazobactam and ofloxacin. 2(66.66%) cases. Pseudomonas aeruginosa
showed sensitivity to piperacillin/tazobactam
In our study, 64 bile samples were gultured & ceftazidime. Among gram positive isolates
for the presence of microorganisms, out of Staphylococcus aureus (MRSA) was sensitive
which 11 (17.19%) showed bacterial growth to vancomycin and linezolid and
which was in accordance with sabir (16%) 6 Enterococcus spp. was sensitive to
and Van Leeuwen (16.4%) 7 . In this study, it piperacillin/tazobactam and ofloxacin.
was observed that the female were commonly
affected and male to female ratio was 1 : 4.33. In Parekh PM et al., 12, it showed that
Study done by Kumar M et al.,8 and Ahmad Piperacilin and tazobactum also shows good
et al., 9 recorded male to female ratio of 1: sensitivity against isolated organism from bile
3.85. In this study Majority of patients and they are more effective against
22(34.37%) found in age group between 51- pseudomonas. In Kumar M et al., 8,
60 years, which is accordance to Gill HS et sensitivity of the organisms grown on bile
al., 10.
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found that Escherichia Coli showed Klebsiella pneumoniae showed maximum

maximum sensitivity to Amoxicillin/ sensitivity to Amoxicillin/Clavulinic acid,
Clavulinic acid, Piperacillin / Tazobactum, Piperacillin/Tazobactum, Imipenem and
Imipenem, Amikacin in 9 (100 %) cases Amikacin in 5(100 %) cases followed by
followed by Gentamycin in 8 (88.89%) cases. Gentamicin, Ceftriaxone, Ceftazidime in 4
Escherichia coli showed high resistance to (80%) cases. Klebsiella spp. showed high
Ciprofloxacin, Ceftazidime in 6 (66.67%) resistance to Ciprofloxacin, Norfloxacin in 4
cases followed by Ceftazidime, (80%) cases followed by Trimethoprim-
Trimethoprim-Sulphamethoxazole in 4 Sulphamethoxazole, Nitrofurantoin in 3
(44.44%) cases. (60%) cases.

Table.1 Organism isolated from bile culture

Organism isolated No. of positive bile culture Percentage

Escherichia coli 04 36.36
Klebsiella pneumoniae 03 27.27
Pseudomonas aeruginosa 01 09.09
Staph. aureus 01 09.09
Enterococcus spp. 01 09.09
CoNS 01 09.09

MALE FEMALE

19%

81%
Fig.A Sex Distribution

INFECTED STERILE

Open 17%
42%
Cholecystectom
58% y
Laparoscopic 83%
Fig.1 Types of surgery done in cholelithiasisCholecystectom
Fig.2 Bile culture result
y
Bile is normally sterile in the gall bladder in biliary tract, in which there is increased
the absence of gallstone or any pathology of prevalence of bacteriobilia. Prophylactic

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antibiotics therapy would be appropriate cholelithiasis (dissertation). Karachi:

according to isolated organisms from bile and College of Physicians and Surgeon
it could prevent postoperative infections. Pakistan 1998.
Prophylactic treatments prevent infections but 7. Van Leeuwen PA, Keeman JN, Butzelaar
not sterilize the bile. RM, Van den Bogaard AE. Correlation
between a positive gallbladder culture and
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How to cite this article:

Md Khalid Anjum, Amber Prasad, Makbul Ansari, Manoj Kumar and Kumari Seema. 2020.
Bacteriological Profile of Bile in Cholecystectomy Patients at Rims, Ranchi, India.
Int.J.Curr.Microbiol.App.Sci. 9(06): 156-160. doi: https://doi.org/10.20546/ijcmas.2020.906.020

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