Evaluating the results of bile culture and antibiogram in cholecystectomized patients hospitalized in Kashan Shahid-Beheshti hospital during 2010-2012

Acute and chronic cholecystitis and cholangitis are common cases in general surgical diseases. Considering the role of infections in pathogenesis of these diseases, prescribing appropriate antibiotics is important to control the biliary tract infections. The aim of this study was to recognize the biliary pathogens as well as evaluate their antibiotic susceptibility in cholecystectomized patients.

This cross-sectional study was performed on 288 cholecystectomized patients with acute and chronic cholecystitis and cholangitis. During the operation, a sterile bile sample was aspirated from the gallbladder which was sent to the laboratory for culture and antibiogram evaluation.

Sixty-two (21.5%) patients were positive for bile culture. There were more positive cultures in cholangitis cases (64.7%) than the acute and chronic cholecystitis (22.8%, 12.2%, respectively; P=0.001). Thirty-six isolated pathogens were E.coli (58%) and 8 Klebsiella (12.9%). Moreover, the most effective antibiotics against the gram-negative bacteria: imipenem (100%), amikacin (98.1%) and gentamicin (90.4%) and for gram-positive bacteria: imipenem, vancomycin, rifampcin and clindamycin.

The third-generation cephalosporins, as an empirical treatment for biliary tract infections, lack the effective antibiotic susceptibility. Considering the high susceptibility (more than 90%) and the reasonable price of amikacin and gentamicin, cephalosporins are recommended as the first line treatment for biliary tract infection. Imipenem, an expensive broad-spectrum antibiotic, is not recommended as the first line treatment to avoid drug resistance.