While the bile in healthy patients is almost always sterile, growth of bacteria in the bile is common in patients with diseases of the biliary tract. The frequency of bacteria in the bile varies in different risk groups and there is often a
direct
correlation between this bacteria and the risk of postoperative infectious complications.
To reevaluate these findings, we prospectively performed a culture from the bile in 177 patients with biliary operations during the recent 17 month period. Of the 286 specimens obtained from the 177 patients, 199 had positive bile
cultures(69.5%).
The
most commonly cultured aerobes E. coli, Klebsiella, and Enterococcus. The most common anaerobe was Bacteroides. Clostridium and Fusobacterium were also isolated. The highly sensitive antibiotics to commonly isolated organisms were amikacin,
ceftriaxone,
tobramycin, gentamicin, and cefamandole and relatively ineffective antibiotis were cephalothin and ampicillin. Clinical risk factors for positive bile cultures were in patients over age 60, with obstructive jaundice, bile duct stones, acute
cholecystitis, preoperative ERCP, and previous operation. Overall septic complication rates were 14.7%. Patients who had positive bile cultures showed significantly higher rates of infection than patients with negative cultures. Organisms
isolated
from
the infected wound were same in about 70% as in the bile. On the basis of these findings, prophylactic antibiotics are recommended to reduce the complication rates in patients with risk factors listed above.
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