Host biliary bacteria in cholecystectomy at a secondary-care teaching hospital, an observational study

The prevalence of cholelithiasis in Mexico is high, and cholecystectomy is a very frequent procedure where antimicrobials are employed, being important to sample and culture the bile fluid to identify local susceptibility to antibiotics to avoid complications and reduce antimicrobial resistance.

An observational, cross-sectional, prospective study was designed to identify bile fluid flora in patients undergoing cholecystectomy in a secondary-care teaching hospital with identification, sensitivity, and antimicrobial resistance testing.

There were 60 patients (47 female and 13 male), which yielded 15 cases with bactibilia. Bacterial identification was Enterococcus faecalis in 6 cases (40%), Escherichia coli in 5 cases (33.3%), Klebsiella pneumoniae in 2 cases (13.3%), and Raoutella planticola and Streptococcus infantarius, each in one patient. E. faecalis, E. coli, R. planticola, and S. infantarius were mostly sensitive to quinolones, whereas K. Pneumoniae was sensitive to carbapenems and tigecycline. Resistance occurred for ampicillin, benzylpenicillin, and trimethoprim/sulfamethoxazole.

Based on our local microbial findings, it is proposed that in cases of acute biliary pathology in patients above the seventh decade of life, empirical antibiotic prophylaxis be used and a bile fluid sample be taken before starting gallbladder dissection, for later adjustment of antibiotic therapy.