Clinical aspects of bile culture in patients undergoing laparoscopic cholecystectomy

Bile is aseptic; under conditions of no external influx, there is a less than 30% chance of isolating bacteria even in acute cholecystitis. This study was conducted to evaluate the incidence of biliary microflora and most common biliary microflora and resistance to antibiotics in patients with cholecystitis, as well as predict situations that do not require the use of prophylactic antibiotics. Bile samples were collected for culture using standard methods during all cholecystectomies performed from January 2015 to December 2015 in the Department of Surgery, Pusan National University Hospital. A total of 366 laparoscopic cholecystectomies were performed during the study period. In 215 patients, bile culture was performed and cultures were positive in 54 cases. Prophylactic antibiotics with 2nd-generation cephalosporin were administered once 30 minutes before surgery. According to the results of bile culture, patients were divided into 2 groups, culture-negative and culture-positive groups. Preoperative, intraoperative, and postoperative factors were compared between groups. The culture positive group was older (P = .000). The number of patients with performance of endoscopic retrograde cholangiopancreatography (ERCP), performance of percutaneous transhepatic gallbladder drainage (PTGBD), presence of symptoms, presence of operative complications, and hospital stay was significantly higher in the culture-positive group than in culture-negative group. In multivariate analysis of factors associated with positive culture, age, ERCP, and symptoms were independent factors affecting positive bile culture. Eighty-five bacteria were identified in 54 patients. Escherichia coli and Klebsiella were common in gram-negative bacteria. Enterococcus was the most common in gram-positive bacteria. Less than 5% resistance was observed against carbapenem, beta-lactam antibiotics, glycopeptide antibiotics, and linezolid. The bile of patients with laparoscopic cholecystectomy may contain microorganisms, particularly elderly patients, those with symptoms, and those who undergo preoperative ERCP. When ERCP was performed, multiple bacteria culture-positive results were more likely to be found. Although carbapenem, beta-lactam antibiotics, glycopeptide antibiotics, and linezolid may be suitable prophylactic antibiotics, additional studies of the clinical aspects of culture-positive bile is needed to determine the importance of bacterial growth in bile.