Bacteriology and antimicrobial choice in hepatolithiasis

Area of Science:

• Hepatobiliary Medicine
• Infectious Diseases
• Microbiology

Background:

• Hepatolithiasis is a prevalent condition in Southeast Asia, frequently causing recurrent acute cholangitis.
• Untreated cholangitis can lead to severe complications including liver abscess, secondary biliary cirrhosis, portal hypertension, and fatal sepsis or hepatic failure.
• Effective antimicrobial therapy is crucial for managing hepatolithiasis alongside stone removal and bile stasis relief.

Purpose of the Study:

• To investigate the bacteriology of hepatolithiasis.
• To identify common pathogens involved in cholangitis associated with hepatolithiasis.
• To provide data for selecting appropriate antimicrobial agents for treatment.

Main Methods:

• Bile specimens were collected via syringe aspiration from the common bile duct of 150 patients undergoing surgery for hepatolithiasis between July 1993 and June 1996.
• Collected bile samples were immediately cultured for both aerobic and anaerobic bacteria.
• Standard surgical intervention was performed on all participating patients.

Main Results:

• Bacteria were detected in the bile of all 150 patients studied.
• The most frequent aerobic isolates included gram-negative bacteria (Klebsiella sp., Escherichia coli, Pseudomonas sp.) and gram-positive Enterococcus sp.
• Bacteroides sp. were the most commonly identified anaerobic bacteria.

Conclusions:

• A strong association exists between acute cholangitis in hepatolithiasis and enteric bacteria.
• Antibiotic therapy for acute cholangitis in hepatolithiasis should initially target common enteric pathogens.
• Treatment should be tailored based on bacteriologic culture results and the patient's clinical status for optimal microbial control.