Biliary tract infections and their Microbiological Spectrum- A study from coastal region of Southern India

Abstract

Objective: Biliary tract infections include cholangitis and cholecystitis. They are associated with high morbidity and mortality in elderly patients with co-morbid disease. The present study was undertaken to determine the microbial aetiology causing biliary tract infections and also to study their antimicrobial resistance profile.Materials & methods: A retrospective study was conducted from January 2011 to December 2016 at the Enteric Diseases Division, Kasturba Medical College Hospital, Manipal. Patients with biliary tract infections admitted in tertiary referral health care hospital, Manipal were included for the study. Aerobic and anaerobic bacteriological and fungal aetiology of biliary tract infections were recorded along with their antimicrobial resistance profile.Results: Out of 307 bile samples sent for aerobic culture and susceptibly testing 187 (60.91%) were positive for culture, of which Escherichia coli (44.4%) was the predominant aetiology followed by Klebsiella pneumoniae (27.3%). Among the 14 samples sent for anaerobic culture, 5 (35.75%) specimens showed growth, of which Bacteroides fragilis group was found to be the predominant anaerobe. Among the 201 bacterial pathogens tested for their antimicrobial susceptibility, 108 (53.73%) isolates were resistant, out of which 9 were PDR Enterobacteriaceae with 12 ESBL strains. All the Candida species were susceptible to fluconazole with the exception of C. glabrata and C. krusei. All the anaerobic isolates were found to be susceptible to Metronidazole.Conclusions: The high rate of bacterial infection particularly gram-negative bacteria was recorded. It is necessary that antimicrobial therapy be initiated when culture or the clinical conditions reports caution. Routine aerobic and anaerobic culturing of bile samples with biliary tract infections are imperatively necessary. With the emergence of multidrug resistant pathogens and change in the microbiological spectrum of biliary tract infections, there is a need for the empirical antimicrobial therapy in every clinical setting.

Retrospective analysis on distribution and antifungal susceptibility profile of Candida in clinical samples: a study from Southern India

“…Among NAC, C. glabrata was recorded in both of their studies individually. Studies from Marak ( 25 ) and Ballal et al ( 26 ) revealed the presence of only NAC in bile which is in line with our study. In a study by Baghdadi et al 2016, C. albicans was the most common species isolated from endotracheal tubes accounting for 35.7%.…”

Pattern of bile cultures and antibiotic sensitivity tests in Sudanese patients diagnosed with obstructive jaundice: A single‐center prospective study

“…This is due to the careful setup in our microbiology laboratory, which led to better pathogen isolation without any delay due to transportation. Our results are consistent with other international studies that reported E. coli as the most common bacterial pathogen found in the bile of malignant biliary obstruction, diabetic patients, and after ERCP intervention 17–21 . Also, E. coli was found to have a strong association with ascending cholangitis, which leads to poor clinical outcome.…”

“…Our results are consistent with other international studies that reported E. coli as the most common bacterial pathogen found in the bile of malignant biliary obstruction, diabetic patients, and after ERCP intervention. 17 , 18 , 19 , 20 , 21 Also, E. coli was found to have a strong association with ascending cholangitis, which leads to poor clinical outcome. We carried out extensive search of published studies in the literature but could not find any specific findings describing poor clinical outcome or poor sepsis control of E. coli .…”

“…are the most commonly observed gram-positive microorganisms. [19][20][21] Gram-positive bacterial infection has attracted attention recently because it is highly detected in cholangitis of liver transplantation patients. [22][23][24] Mohammed et al showed that the consequences of bacteriobilia can be prevented by pre-operative and postoperative antibiotics that act on the common digestive tract pathogens such as enterobacters and anaerobes.…”

“…are the most commonly observed gram‐positive microorganisms. 19 , 20 , 21 Gram‐positive bacterial infection has attracted attention recently because it is highly detected in cholangitis of liver transplantation patients. 22 , 23 , 24 Mohammed et al .…”