The bacterial flora of the biliary tract and liver in man

Dye, Mary; Macdonald, A. G.; Smith, Gordon I.

doi:10.1002/bjs.1800650419

Cited by 40 publications

(15 citation statements)

References 8 publications

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“…Cefoperazone, which was effective in vitro against P. aeruginosa isolated in this study, sterilized the bile of two patients harboring this agent. As reported previously, P. aeruginosa was observed exclusively in patients with cancer (1,5,10,36). Anaerobes were recovered from six patients.…”

Section: Discussionsupporting

confidence: 76%

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Cefoperazone compared with ampicillin plus tobramycin for severe biliary tract infections

Bergeron

Mendelson

Harding

et al. 1988

Antimicrob Agents Chemother

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In a prospective, randomized, multicenter study, the efficacy and safety of cefoperazone and the combination ampicillin-tobramycin as initial therapy for patients with severe acute biliary tract infections were compared. Of 77 patients initially entered in the study, definite severe biliary tract infection was confirmed in 67. Sixty-four patients completed treatment. At the end of treatment, 35 of 36 (97%) patients given cefoperazone and 23 of 28 (82%) given ampicillin-tobramycin were cured of their infection (P = 0.07). Pathogens were recovered from the bile in 32 patients; microbiological cures were observed in 18 of 19 (94%) patients receiving cefoperazone and 8 of 13 (62%) receiving ampicillin-tobramycin (P = 0.03). Thirteen patients had septicemia. None (0%) of the eight septicemic patients from the cefoperazone group, but two of five (40%) from the ampicillin-tobramycin group, were clinical failures. Of the isolated pathogens, 51% were resistant to ampicillin, while the resistance rate was 4% for tobramycin and 1% for cefoperazone (P < 0.001). Biliary concentrations of cefoperazone were maintained at high levels-236 ± 87

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Section: Discussionsupporting

confidence: 76%

“…In fact, unless cholecystitis occurs in an older patient or is associated with cystic or common bile duct obstruction (1,10,36), the incidence of active infection is less than 50% (11,32).…”

Section: Discussionmentioning

confidence: 99%

Cefoperazone compared with ampicillin plus tobramycin for severe biliary tract infections

Bergeron

Mendelson

Harding

et al. 1988

Antimicrob Agents Chemother

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“…For example, bacterial infection was found in bile juice (20%) and the liver (17%) on post-operative individuals without any hepato-biliary abnormalities. 23 Also, patients who underwent non-biliary abdominal surgery had a 32% positive rate of bacterial infection in their portal blood. 24 Leung et al 2 found bacteria in 84% of the inner cut surface of the pigmented gallstones but not cholesterol stones using electron microscopy.…”

Section: Discussionmentioning

confidence: 99%

Identification of Helicobacter pylori in Gallstone, Bile, and Other Hepatobiliary Tissues of Patients with Cholecystitis

Lee

et al. 2010

Gut Liver

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Background/Aims: Bacterial infection is accepted as a precipitating factor in cholesterol gallstone formation, and recent studies have revealed the presence of Helicobacter species in the hepatobiliary system. We utilized the polymerase chain reaction (PCR) to establish the presence of bacterial DNA, including from Helicobacter species, in gallstones, bile juice, and gallbladder mucosa from patients with gallstones. Methods: At cholecystectomy, 58 gallstones, 48 bile samples, and 46 gallbladder mucosa specimens were obtained and subjected to nested PCR using specific 16S rRNA primers of H. pylori and other bacteria. Bacterial species were identified by DNA sequencing analysis. Bacterial 16S rRNA was detected in 25 out of 36 mixed-cholesterol gallstones, 1 out of 10 purecholesterol gallstones, and 9 out of 12 pigmented stones. Furthermore, 16S rDNA sequencing identified Escherichia coli, Pseudomonas, Citrobacter, Klebsiella, and Helicobacter species. Results: Helicobacter DNA was detected in 4 out of 58 gallstones, 6 out of 48 bile samples, and 5 out of 46 gallbladder specimens. Direct sequencing of Helicobacter amplicons confirmed strains of H. pylori in all four gallstones, five out of six bile samples, and three out of five gallbladder specimens. Almost all mixed-cholesterol gallstones appear to harbor bacterial DNA, predominantly E. coli. Conclusions: H. pylori was also found in the biliary system, suggesting that these bacteria are of etiological importance in gallstone formation. (Gut Liver 2010; 4:60-67)

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“…There has been uncertainty whether bacteria are nor mally present in bile in man, although it has been stated that this is quite possible in many animals [33]. Other investigators have pro duced data that, at least in man, the bile is normally sterile above the cystic duct region [34][35][36] and that the gallbladder could have provided the bacteria in obstructions below the cystic duct.…”

Section: Ascending Routementioning

confidence: 99%

“…However, in the ab sence of initial obstruction, the mechanical flow of bile should keep the bile ducts sterile. The gallbladder has been considered the source of bacteria in some cases of obstruc tive cholangitis [34][35][36], although where the gallbladder is normal, there is often no infec tion [36]. The gallbladder in RPC is often normal and/or without calculus in two thirds of the patients, so that it is unlikely to be the major source of infecting organisms [21,[25][26][27], The observation that early changes of RPC as dectected by endoscopic retrograde cholangiography are usually confined to the intrahepatic ducts [26] also speaks against the ascending route of infection.…”

Section: Ascending Routementioning

confidence: 99%