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Biliary infection; distribution of species and antibiogram study. | LitMetric

AI Article Synopsis

  • Biliary infections, such as cholecystitis and cholangitis, are common and potentially life-threatening, necessitating careful antibiotic treatment and ongoing monitoring for bacterial resistance.
  • A study involved 2288 patients undergoing cholecystectomy, revealing that 21.5% had positive bacterial cultures, predominantly among those with cholangitis, with E. coli and Klebsiella being the most frequently isolated pathogens.
  • Results suggested that cephalosporins are ineffective for treating these infections; instead, aminoglycosides like amikacin and gentamicin should be prioritized for first-line therapy due to their high sensitivity and cost-effectiveness, while imipenem should be reserved for resistant strains.

Article Abstract

Background: Biliary infections like cholecystitis and cholangitis are common and could be life threatening if treated inappropriate. Prescribing antibiotics is the key to control such infections. Occurrence of bacterial resistance to antibiotics is highly probable and should be continuously monitored. This study aimed to re-evaluate bacterial species distribution and their interaction to antibiotics in biliary infections.

Method: Total 2288 patients who were diagnosed as whether acute or chronic cholecystitis with/without concurrent cholangitis enrolled in this cohort study. All were candidate for cholecystectomy operation. In the theatre a sterile bile sample was aspirated from the gallbladder as early as the organ was exposed. Analysis was performed on culture and antibiogram results.

Results: Finally 492 (21.5%) microorganism growth was seen in all culture environments. Bacterial colonization was most common in cholangitis (63.8%) which followed by acute (26%) and chronic (10.9%) cholecystitis respectively ( = 0.001). (58%) and Klebsiella species (12.2%) were mostly isolated pathogens. Antibiogram study illustrated bacterial sensitivity of gram-negative pathogens to imipenem (100%), amikacin (98.1%), and gentamicin (90.4%) which in gram-positive bacterial species was 100% to imipenem, vancomycin, rifampcin, and clindamycin.

Conclusion: Cephalosporins as an empirical treatment for biliary infections is not suitable. Aminoglycosides including amikacin and gentamycin are costly beneficial as the first line for empirical antibiotic therapy in selected patients because of their good bacterial sensitivity and low expenses. Imipenem should remain for multidrug resistance species.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8435813PMC
http://dx.doi.org/10.1016/j.amsu.2021.102822DOI Listing

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