INTRODUCTIONRoutine intra-operative bile culture during biliary tract surgeries is a common practice among hepatobiliary surgeons. This is based on reports that bactibilia is a predictor of septic complications following these surgeries.
1,2Most of these studies have focused on impact of pre-operative biliary drainage on the biliary microflora and its resulting infectious complications. Bile-contaminated operations are reported to have a higher incidence of septic complications than non-bilecontaminated operations.
3There is high correlation of bile culture results with those from post-operative septic foci with concordance rates as high as 80-89%.4-6 Intra operative bile culture result was thus purported to guide early institution of appropriate in patients at risk of developing infectious complications and guide selection of appropriate antibiotic prophylaxis. This study was aimed at studying the microbiological profile of routine intraoperative bile cultures and correlate with the isolates from septic foci in those undergoing biliary tract surgeries.
ABSTRACTBackground: Routine intra-operative bile culture during biliary tract surgeries is a common practice among hepatobiliary surgeons. This is based on reports that bactibilia is a predictor of septic complications following these surgeries. This study was aimed at studying the microbiological profile of routine intraoperative bile cultures and correlate with the isolates from septic foci in those undergoing biliary tract surgeries. Methods: A prospective database of all patients who underwent biliary tract surgeries between July2014 to June 2016 was taken up for analysis. Charts were reviewed with special focus on microbiological culture data yielded from both routine bile culture and those from septic complications were recorded and analyzed. Strain typing screening was done by comparing the antibiotic susceptibility profiles of various isolates in each patient. Results: Of the total one hundred and forty four patients undergoing biliary tract surgery, 46 patients (32%) had a positive bile culture. Of these cultures were positive in 30 out of 32 patients (94%) who had preoperative CBD stent in situ. Bile culture positivity rate was highest with CBD exploration cases and incidence of surgical site infections (SSI) was highest with pancreatoduodenectomy cases. There was no significant association between a positive bile culture and development of surgical site infection (p = 0.09). Conclusions: There is no significant association of a positive bile culture with risk of surgical site infections in patients undergoing biliary tract surgery. Even in patients with positive bile culture who develop surgical site infections, two third of them are caused by different strains.
Malabsorption syndrome (MAS) is a common condition in India. In Indian adults, tropical sprue and celiac disease are leading causes of MAS. Sometimes, the diagnosis of MAS may pose a challenge due to the varied signs and symptoms. We present a case of MAS in a young female, whose presenting symptoms were mainly neurological. She was successfully treated under regular follow-up for the past 6 years without any symptoms.
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