Biliary sepsis. Reviewing treatment options

Area of Science:

• Gastroenterology
• Infectious Diseases
• Pharmacology

Background:

• Bactobilia, the presence of bacteria in bile, frequently occurs with biliary tract obstruction.
• Bacterial colonization can be asymptomatic, lead to postoperative infections, or cause acute cholecystitis.
• Intestinal aerobes and anaerobes are the common organisms involved in bactobilia.

Purpose of the Study:

• To review antimicrobial strategies for biliary tract infections.
• To guide the selection of antibiotics based on expected sensitivities, obstruction, and antibiotic activity in bile.
• To define appropriate surgical prophylaxis and treatment regimens for acute cholecystitis and cholangitis.

Main Methods:

• Literature review of studies on bactobilia and biliary tract infections.
• Analysis of antimicrobial efficacy and pharmacokinetic properties in the biliary system.
• Evaluation of guidelines for surgical prophylaxis and therapeutic interventions.

Main Results:

• Antimicrobial choice for biliary infections requires consideration of organism sensitivities, obstruction, and antibiotic bile penetration.
• High blood and tissue concentrations are often more critical than high biliary concentrations due to obstruction.
• Effective single-dose perioperative prophylaxis includes cephalosporins, gentamicin, or co-trimoxazole for high-risk patients.
• Treatment for acute cholecystitis and cholangitis varies based on severity, with specific recommendations for oral and intravenous regimens.
• Recurrent cholangitis may involve antibiotic-resistant bacteria, necessitating bacteriological diagnosis.

Conclusions:

• Optimal management of bactobilia and associated infections hinges on judicious antimicrobial selection and administration.
• Surgical prophylaxis is recommended for high-risk individuals, particularly with biliary obstruction.
• Tailored antibiotic therapy, considering patient condition and causative organisms, is essential for acute cholecystitis and cholangitis.