THE STUDY OF INCIDENCE OF BILIARY INFECTION IN GALL STONE DISEASE IN A HOSPITAL
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 47
Abstract
BACKGROUND Biliary calculus disease is one of the most common disorders affecting the gastrointestinal tract and is an important cause of morbidity. In about half of the cases, bacteria can be cultured from the gallbladder bile. Infective factor seems to be a major cause of formation of gallstones. Moynihan’s aphorism that “gall stone is a tomb stone erected in the memory of the organism with in it” is true today.1 Evidence in favour of infection includes isolation of E. coli, bacterium typhosum, streptococcus from the gallbladder bile and from the centre of the gallstones.2 Knowing the bacteriological aetiology will help in prevention as well as better treatment of gallstone disease in the future. MATERIALS AND METHODS This is descriptive study which includes cases of cholelithiasis, age between 21 to 80 years, who underwent cholecystectomy from June 2014 to June 2016 at CPR Hospital attached to RCSM Government Medical College Kolhapur . Cases of acute cholecystitis, acute acalculous cholecystitis, empyema, mucocele were excluded from the study. The objectives of this study were 1. to determine frequency of infection in cholelithiasis, 2. to find common infecting organisms and 3. To determine their antibiotic sensitivity. Sample size was calculated as 100 using Sample Size formula Sample size =Z 2 * (p) * (1-p)/c 2. Relevant laboratory investigations like CBC, BSL, LFT with liver enzymes were done. Relevant radiographic investigations like USG were done. Patients were operated either by open or laparoscopic technique. Antimicrobial prophylaxis with 1 gm Ceftriaxone preoperatively and patients who had diabetes mellitus or spillage of bile or stone into the peritoneal cavity continued receiving 1 gm Ceftriaxone every 12 hours postoperatively. Bile and gallstones collected by sterile technique were then put into sterile bottles and transferred to laboratory where they were crushed and cultured to identify organisms and their sensitivity. Statistical analysis was done by Chi square test and Fisher’s exact tests. RESULTS All patients had cholelithiasis and chronic cholecystitis. Bacteria were isolated in 36 samples (36%). Frequency of isolated bacteria in females and males had no significant difference (P>0.05). Monomicrobial and polymicrobial infection were observed in 34 (94%) and 2 (6%) respectively. E. coli was the most common isolate (12; 33%). Enterobacter was the second one (8; 22%). The antibiotics to which organisms were sensitive were Cefepime, Ceftriaxone, Imipenem, Amikacin, Gentamycin and Ciprofloxacin. CONCLUSION 1. Most common organism detected in bile culture was E. Coli followed by enterococcus and anaerobic bacteria. 2. Most effective antibiotic in bile and stone culture positive cases were Cefepime, Ceftriaxone, Imipenem, Amikacin, Gentamycin and Ciprofloxacin. 3. We recommend starting antibiotics selectively, if supported by the clinical conditions or co-morbidities like diabetes or immune-compromised states and culture positive in SSI wound infections according to its culture and sensitivity, in case of cholecystitis and cholelithiasis.
Authors and Affiliations
Vasantrao Deshmukh, Ramprasad Rajebhosale, Kaustubh Mench, Madhur Joshi
Keywords
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- EP ID EP548162
- DOI 10.14260/jemds/2018/1135
- Views 90
- Downloads 0
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