Biliary bacteria: significance and alterations after antibiotic therapy

Area of Science:

• Hepatobiliary Surgery
• Surgical Infectious Diseases
• Clinical Microbiology

Background:

• Bactibilia, the presence of bacteria in bile, is a concern in patients undergoing biliary operations.
• The impact of bactibilia on postoperative complications requires further investigation.
• The influence of antibiotic therapy on biliary bacteriology in this context is not well-defined.

Purpose of the Study:

• To determine if bactibilia is associated with postoperative complications.
• To assess the effect of antibiotic therapy on biliary bacteriology in patients undergoing urgent and complex biliary operations.

Main Methods:

• Prospective study of 134 patients undergoing urgent and complex biliary operations.
• Aerobic and anaerobic bile cultures performed intraoperatively.
• Repeat bile cultures conducted postoperatively in 111 patients with indwelling biliary tubes.

Main Results:

• Positive operative bile cultures correlated with increased wound infections and postoperative renal dysfunction.
• Postoperative bile cultures revealed a higher incidence of bactibilia and altered microbial profiles.
• Anaerobes were isolated in 15% of operative and 23% of postoperative cultures.
• Antibiotic therapy altered, but did not eradicate, biliary bacteria.
• Prolonged aminoglycoside therapy was linked to significant renal dysfunction, particularly in elderly patients.

Conclusions:

• Bactibilia is associated with increased postoperative complications, including wound infections and renal dysfunction.
• Antibiotic therapy modifies biliary bacteriology rather than sterilizing bile.
• Careful consideration of antibiotic duration and type is crucial, especially regarding nephrotoxicity in elderly patients.