Correlation of intra-operative bile cultures with septic complications following biliary tract surgery

Abstract

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.

Topical Use of Gentamicin in Potentially Contaminated Laparoscopic Cholecystectomy After Bile Spillage During Gall Bladder Retrieval

“…In contrast to our study, a recent study conducted in India concluded with the insignificant association of a positive bile culture with the risk of surgical site infections after biliary tract surgery. 16 Though we did not take bile culture and compare it with the pus culture from SSI, we did focus on the prophylactic approach to prevent SSI after the incidence of bile spillage. Our study has also documented a higher incidence of SSI after bile spillage than clean surgery.…”

“…Another study concluded that in patients with positive bile culture who develop surgical site infections, two-thirds of them are caused by different strains. 16 This means that port-site infections after laparoscopic cholecystectomy can be caused by contamination of both bile and surroundings and a wide range of microbes are responsible for them. Therefore, just using a prophylactic antibiotic against microorganisms present in bile cannot solve our problem.…”