Clinical observation was carried out on 40 cases of cholecystitis with proved bacterial infection and bacteriological study was made in an effort to assess the incidence of drug resistance and the distribution of R factors in Escherichia coli isolated from bile, and influence of bile upon the bacteria growth.
Age of patients ranged from 16 to 69 years and the highest incidence was noticed in the 5th decade. There was no significant difference in sex distribution. The prominent symptoms and signs were abdominal pain (92.5%), abdominal, tenderness(90% fever, (75%), nausea and vomiting (52.5%), jaundice (40%) and palpable gallbladders (30%). The interval from recent onset to admission was 4 days and more in 82.5% of all the cases.
Laboratory examination showed leukocytosis (75%), hyperbilirubinemia(58. 8%) and elevated serum alkaline phosphatase (58.8%). On intravenous cholangiograms, there were 17 cases of nonvisualizing gallbladders and 5 cases of good visualization. Operation revealed 12 cases of stones in the former and stones (3 cases), ascaris lumbricoides impacted in bile duct(1 case)and chronic inflammation alone (1 case) in the latter.
Possible etiologic factors were cholelithiasis in 28 cases (70%), ascaris lumbricoides impacted in bile duct in 5 cases, of which 2 cases were associated with stones, clonorchis ,sinensis impacted in common bile duct in 2 cases, liver abscess in 2 cases
and typhoid fever in 1 case. Associated diseases were empyema of gallbladder (10 cases), bile peritonitis, cholangitis and biliary cirrhosis.
The most common organisms cultured from bile were Escherichia coli (23 cases), Klebsiella-Aerobacter, Staphylococci and Streptococci in the decreasing order of frequency. Drug susceptibility test of isolated Escherichia coli revealed highly sensitive on nalidixic acid and minocycline, and next on chloramphenicol and streptomycin, while resistant strains to ampicillin were most frequent.
Seven different R factors were isolated from seven resistant strains of six different patterns, of which R(KM SM CP AP TC) was also found.
The growth of Escherichia coli, Salmonella typhi, Pseudomonas aerugionosa, Klebsiella pneumoniae and specially Staphylococcus aureus was inhibited by increasing ratio of bile to nutrient broth, and minimum inoculum yielding recovery in bile media were usually between 102/ml and 103/ml.
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