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Aims: The emerging biliary colonization of microorganisms in patients with biliary diseases may be devastating. Recent evidence suggests that age and gender may influence changes in the microbial composition of gut microbiota. To study the relationship between these parameters on bile microbiota, we retrospectively reviewed positive bile cultures following an endoscopic retrograde cholangiopancreatography (ERCP) in a QA-certified academic surgical unit of a single institution. Methods: 449 positive bile cultures from 172 Italian patients with diseases of the biliopancreatic system hospitalized from 2006 through 2017 were investigated for aerobic, anaerobic, and fungal organisms. The patients were stratified into four age intervals (22−66, 67−74, 75−81, and 82−93 years) and followed up for five years. Results: Gram-positive bacteria (GPB) was negatively associated with age only in multivariate analysis (Rpartial = −0.114, p = 0.017), with younger patients prone to harbor GPB and older patients likely to have Gram-negative bacteria (GNB). There was a definite link with the male gender using both univariate and multivariate analysis (p < 0.001). Enterococcus spp. was the most common strain identified in patients with GPB except for patients aged 67−74 years for male (95.2%) and female (80.9%) patients. Escherichia coli and Klebsiella spp. were most frequent than others in every group analyzed. Analogous results were found for bacteria Non-fermenting Gram-negative bacilli (NFGNB), such as Pseudomonas spp. and Stenotrophomonas spp. apart of the 2nd quartile. Conclusions: Our study strengthens the bond of age and gender with bile microbiota composition and suggests that further investigations may be required in targeting the aging microbiome. Other studies should also focus on Mediterranean epidemiological characteristics and antibiotic resistance surveillance system strategies

Purpose. Bile is a hepatobiliary lipid-rich sterile solution, and its colonization by microorganisms defines the condition of bactibilia. In this study, we aimed to assess the bile microbiological flora and its potential link with comorbidity in women. Methodology. We performed a microbiologic investigation on 53 female patients with biliopancreatic diseases who granted consent, and we analysed the data using a MATLAB platform. Results. We found that the most frequent disease associated with bactibilia was pancreas head carcinoma (PHC) (P=0.0015), while the least frequent disease was gall bladder carcinoma (GBC) (P=0.0002). The most common microorganisms were Pseudomonas spp. (P

Background Cholecystocentesis can be part of the diagnostic workup of hepatobiliary disease in small animals, but literature on cytological evaluation of bile is scant. Objectives To determine the diagnostic utility of cytological assessment of bile aspirates. Animals Fifty-six and 78 client-owned dogs and cats, respectively, with bile collected by cholecystocentesis and submitted to our diagnostic laboratory between 1999 and 2014. Methods Retrospective study describing cytological findings of bile, concurrent bacterial culture results, hematological and serum biochemical data, gallbladder biopsy results, as well as final diagnosis and complications after cholecystocentesis. Results Infectious agents were found in 30% of canine and 22% of feline bile aspirates, and inflammation in 5% and 19% respectively. Presence of microorganisms was more often detected on cytological examination (24%) than by culture (21%). The most common bacterial isolates were Escherichia coli and Enterococcus spp., isolated from 14.8% and 6.7% of cultured samples respectively. Only increased canine pancreatic lipase immunoreactivity concentration (cPLI) was significantly associated with the presence of microorganisms, inflammatory cells, or both in bile. Clinically relevant complications of cholecystocentesis occurred in 2 dogs. The majority of the animals undergoing cholecystocentesis suffered from hepatic, pancreatic, gastrointestinal disease, or a combination thereof. Conclusions and Clinical Importance Cytological examination of bile is inexpensive and straightforward, and yields diagnostically relevant information that precedes and complements bacterial culture.

A prospective study was carried out between July 1999 and July 2001, of 50 patients of both sexes, between 16 and 80 years of age, hospitalized in the Surgery ward of the Chiquinquirá Hospital in Maracaibo, and diagnosed with the pathology of non-acute, lithiasic or non-lithiasic bile infection. All were to undergo surgery of the biliar tree, for the purpose of determine the frequency of biliar infection, to establish the specific antibiotic sensibility of the bacteria in bile culture, to reduce the cost of therapeutic expenses, and to identify the most frequent specimens. The ages in which there was greater affectation was in the third and fourth decades of life. The female sex is most affected, with a total of 96% of the patients under study. The number of cultures that were positive was significantly high (35%). Gallbladder bile and choledocol duct cultures in which there was bacterial growth were appropriately the same, 18 (36%), against 17 (34%). The microorganisms that were isolated on most occasions were 9 aerobic bacteria (75%), and of these, the ones that grew with more frequency were the gram negative species (77.8%), and of these, the one that was more frequently positive in the cultures was Escherichia coli in 28.5% of the cases. Bacillus gram negative bacteria were reported as sensitive to antibiotics of the aminoglycosides and quinolons types, and sensitive to betalactamics that were administered in association with the inhibiting compound, betalactamase. The gram positive enterococcus isolate showed sensitivity to penicillin and its natural and synthetic derivates as well as to those associated with betalactamase inhibitors. The anaerobic bacteria that grew was reported sensitive to penicillin and cephalosporins of third and fourth generation, as well as to betalactamics associated with the inhibitors of the enzyme betalactamase. Resumen: Se realizó un estudio prospectivo entre julio de 1999 y julio de 2001, en 50 pacientes de ambos sexos, realizándose en cada uno cultivo de bilis vesicular y coledociano, con edades comprendidas entre los 16 y 80 años, hospitalizados en el Servicio de Cirugía del Hospital Chiquinquirá de Maracaibo con diagnóstico de patología biliar no aguda, litiásica o no litiásica para ser intervenidos en el árbol biliar, con el propósito de determinar la frecuencia de infección biliar, establecer la sensibilidad antibiótica específica de las bacterias en cultivos de bilis, reducir el costo del gasto terapéutico e identificar los especímenes más frecuentes. Las edades más afectadas son la tercera y cuarta década de la vida. El sexo femenino es el más afectado, con 96% de los pacientes objeto de estudio. El número de cultivos positivos fue significativamente alto (35%). Los cultivos de bilis vesicular y del conducto colédoco en los cuales hubo crecimiento bacteriano fueron aproximadamente iguales, 18 (36%), contra 17 (34%). Los microorganismos aislados en más ocasiones fueron las bacterias aerobias 9 (35%), y de éstas las que crecieron con más frecuencia fueron las especies Gram negativas (77.8%), de estas últimas la que más se aisló fue Escherichia coli en 28.5%. Las bacterias del tipo bacilos Gram negativos se reportaron sensibles a los aminoglucósidos y quinolonas, con sensibilidad a betalactámicos que se administran asociados a los compuestos inhibidores de la enzima betalactamasa. Los enterococos gram positivos aislados se mostraron sensibles a penicilina y sus derivados naturales y sintéticos, así como a los asociados a los inhibidores de betalactamasa. Las bacterias anaerobias que crecieron se reportaron sensibles a penicilinas y cefalosporinas de tercera y cuarta generación, así como a estos betalactámicos asociados a los inhibidores de la enzima betalactamasa.

OBJETIVO: Determinar uma associação entre o quadro clínico pré-operatório e os resultados das culturas de bile e da parece vesicular. CASUÍSTICA E MÉTODOS: Foram estudadas 28 variáveis considerando-se história clínica, exame físico e investigação laboratorial em 38 doentes portadores de colecistite aguda calculosa, submetidos à cirurgia de urgência. Este estudo prospectivo foi realizado em 19 meses, entre novembro de 1995 a maio de 1997. Foram realizadas culturas para agentes anaeróbios e aeróbios, em três diferentes meios de cultura (BACTEC 9240, BHI e HEMOBAC). RESULTADOS: Foram isoladas bactérias em pelo menos um meio de cultura em 68,2% dos doentes. Pela análise univariada, foram identificadas cinco variáveis pré-operatórias como preditivas de bacteriobilia: idade acima de 55 anos, temperatura diferencial axilo-retal maior do que 0,4°C, leucocitose acima de 12000 cels/mm³, neutrofilia acima de 75% e neutrófilos bastonetes acima de 4%. Devido ao pequeno tamanho da amostra, não pôde ser observada significância estatística por regressão logística, embora pudesse ser observada em 98% uma tendência para determinação pré-operatória dos indivíduos com cultura positiva por meio do modelo baseado na idade e porcentagem de neutrófilos bastonetes. Pela análise em conjunto dos fatores preditivos, pôde-se observar que doentes com mais de um fator preditivo têm uma possibilidade significantemente maior para cultura positiva, quando comparado com aqueles com fator preditivo de bacteriobilia. CONCLUSÃO: Conclui-se, portanto, que pela utilização de dados facilmente disponíveis em doentes com colecistite aguda calculosa, a bacteriobilia pode ser previsível no pré-operatório,. OBJECTIVE: to determine an association between the preoperative clinical status and the result of bile and gallbladder wall cultures. MATERIAL AND METHODS: 28 variables regarding history, physical examination and laboratorial assessment in 38 patients with acute calculosis cholecystitis submitted to urgency surgery were prospectively studied during a 19-month period, between November 1995 and May 1997. Cultures for aerobic and anaerobic agents from both the gallbladder wall and the bile were performed, in three different culture media (BACTEC 9240, BHI and HEMOBAC). RESULTS: bacteria were isolated in at least one culture medium, in 68.2% of the patients. At univariate analysis, five preoperative factors were identified as predictors of bactibilia: over 55 years of age, a greater than 0.4°C difference in the axillary-rectal temperature, a greater than 12.000 cels/m³ blood leukocyte count, a greater than 75% neutrophil percentage and a greater than 4% rod neutrophil percentage. Owing to the small sample size, statistical significance of the series could not be noted by logistic regression, although a trend to preoperative determination could be observed in 98% of the subjects with positive culture, by means of the model based on age and percentage of rod neutrophil. By analyzing predictive factors jointly, it was noted that patients with more than one predictive factor have a significantly greater possibility to yelding positive culture when compared to those with up to one predictive factor for bactibilia. CONCLUSIONS: We concluded that, in patients with acute calculosis cholecystitis, bactibilia may be predicted yet at the preoperative period, by using simple and easily obtained data.

AIMS: To determine the prevalence of bactibilia in patients undergoing cholecystectomy and to relate the presence or absence of organisms to the preoperative and postoperative course. PATIENTS AND METHODS: Patients undergoing cholecystectomy under the care of a single consultant surgeon during a continuous 5-year period were identified from a prospectively maintained departmental database. Symptoms, clinical signs, findings of investigations, details of treatment and postoperative care were noted. Risk factors for bactibilia (acute cholecystitis, common duct stones, emergency surgery, intraoperative findings and age > 70 years) were documented. Patients were divided according to the presence (B + ) or absence (B-) of bacteria on culture of their bile. RESULTS: In all, 128/180 (70%) of cholecystectomies had full data available for analysis. Bacteria were identified in the bile of 20 (15.6%) patients (B+ group). The B+ group was significantly older at 63.78+/-9.7 versus 61.62+/-13.9 (p or = 1 risk factor, while these factors were present in only 29/108 (30.3%) of patients in the B- group (p

Objectives Whilst there are theoretical benefits from pre-operatively draining the biliary tree prior to pancreatoduodenectomy (PD), the current literature does not support this intervention. The aim of this study was to explore the relationship between pre-operative stenting, bactibilia and outcome in a large United Kingdom tertiary referral practice. Methods Patients undergoing PD were identified from a prospectively maintained database. The presence or absence of a stent prior to PD, and the results of bile cultures taken at PD were related to the subsequent post-operative course and the development of complications. Results 280 patients underwent PD for periampullary malignancies, all of whom presented with jaundice. 118 patients were stented prior to referral (98 ERCP, 20 PTC). Bile cultures were positive more frequently in the stent group (83% vs . 55%; p = 0.000002) and bactibilia was more common after ERCP than PTC (83% vs . 56%; p = 0.006). The overall prevalence of complications was 54% in the stented and 41% in the non-stented group ( p = 0.03) with statistical significance achieved for pancreatic leak ( p = 0.013) and haemorrhagic complications ( p = 0.03). Comparing stent with no stent, there as no difference in the 30-day mortalities (8.5% vs. 6.8%; p = 0.6) or the 1-year mortality rates (35% vs. 28%; p = 0.21). Mortality rates in the infection versus no infection groups were comparable at 30 days (8.5% vs. 5.5%; p = 0.21), and at 1 year (30.7% vs. 26.4%; p = 0.25). Conclusions Pre-operative stent insertion prior to PD is associated with increased morbidity but not mortality and this is greatest for stents placed at ERCP.