MICROBIOLOGICAL ANALYSIS OF BILE IN PATIENTS WITH BENIGN AND MALIGNANT BILIOPANCREATIC DISEASES AND ITS CONSEQUENCES

ALVES, José Roberto; SILVA, Rodrigo do Carmo; GUERRA, Sâmea Costa Pinheiro; FREITAS, Tiago Tavares de; SOUZA, Dyego Leandro Bezerra de; AMICO, Enio Campos

doi:10.1590/S0004-28032016000300007

Acessibilidade / Reportar erro

Brasil

Arquivos de Gastroenterologia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • Arq. Gastroenterol. 53 (3) • Jul-Sep 2016 • https://doi.org/10.1590/S0004-28032016000300007 copy

MICROBIOLOGICAL ANALYSIS OF BILE IN PATIENTS WITH BENIGN AND MALIGNANT BILIOPANCREATIC DISEASES AND ITS CONSEQUENCES

Análise microbiológica da bile em pacientes com doenças biliopancreáticas benignas e malignas e suas consequências

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background

Bactibilia has several consequences to human health.

Objetive

Assessing the bile microbiology of patients with biliopancreatic diseases in order to identify bacteria and their possible infectious complications.

Methods

Retrospective study of 30 bile culture samples from patients with benign and malignant biliopancreatic diseases. The samples were assessed to set the bile microbiological flora and to search for its possible link with comorbidity, carcinogenesis and postoperative infectious complications.

Results

Thirty bile samples from patients at mean age ≈57.7 years, mostly female (n=18), were assessed. Bactibilia was found in 12 cases, mostly in patients with benign diseases (n=8), older than 50 years (n=23) and female (n=10). Adenocarcinoma of the duodenal papilla (n=9) and cholelithiasis (n=8) were the most common diseases. Escherichia coli (n=5) and Klebsiella sp (n=3) were predominantly found in patients with benign diseases; and Klebsiella sp (n=2) and Streptococcus sp (n=2) were prevalent in cancer patients. There were postoperative infectious complications in seven cases, five of them in bactibilia-associated patients (P=0.084).

Conclusion

Bactibilia was found in 12 samples and Escherichia coli and Klebsiella sp were most often identified in patients with benign diseases, as well as Streptococcus sp and Klebsiella sp in cancer patients. There was a trend of higher postoperative infectious complication incidence in patients with bactibilia.

HEADINGS
Microbiology; Bile; Cholecystectomy; Postoperative complications; Carcinogenesis

N	G	Ag.	Underlying diseases	Type of surgical approach	Identified bacteria
			GROUP 1
1	F	69	Acalculous CC	Laparotomy	-
2	F	87	Calculous CCa	Laparotomy	E. coli + Enterococcus sp.
3	F	51	Calculous CCa	Videolaparoscopy	Enterobacter spb + Nonfermenter GNB
4	F	53	Choledochal cyst and calculous CC	Laparotomy	E. coli + Streptococcus sp
5	F	81	Choledocolithiasis	Videolaparoscopy	E. coli b
6	F	75	Calculous CCa	Laparotomy	-
7	M	83	Choledocolithiasis	Laparotomy	Klebsiella sp b + E. coli + ProteusVulgari b
8	M	52	Calculous CC	Laparotomy	-
9	F	22	Calculous CC	Laparotomy	Enterobacter sp.
10c	F	55	Choledocolithiasis	Laparotomy	E. coli + Klebsiella sp
11	F	61	Calculous CC	Laparotomy	Klebsiella sp.
12	F	29	Calculous CCa	Laparotomy	-
			GROUP 2
13	F	63	Adenocarcinoma of the duodenal papilla	Laparotomy	Klebsiella sp.
14	M	44	Adenocarcinoma of the duodenal papilla	Laparotomy	-
15	M	35	Adenocarcinoma of the duodenal papilla	Laparotomy	-
16	F	51	Adenocarcinoma of the duodenal papilla	Laparotomy	Klebsiella sp.
17	M	61	Adenocarcinoma of the duodenal papilla	Laparotomy	Streptococcus sp.
18	M	65	Adenocarcinoma of the duodenal papilla	Laparotomy	-
19	F	42	Adenocarcinoma of the duodenal papilla	Laparotomy	-
20	F	56	Adenocarcinoma of the duodenal papilla	Laparotomy	-
21	M	66	Adenocarcinoma of the duodenal papilla	Laparotomy	-
22	M	43	Cholangiocarcinoma in the distal part of the common bile duct	Laparotomy	-
23	M	69	Adenocarcinoma of the pancreas	Laparotomy	-
24	M	74	Adenocarcinoma of the pancreas	Laparotomy	-
25	M	52	Adenocarcinoma of the pancreas	Laparotomy	-
26c	F	51	Adenocarcinoma of the pancreas	Laparotomy	-
27	F	69	Adenocarcinoma of the pancreas	Laparotomy	-
28	M	71	Adenocarcinoma of the pancreas	Laparotomy	-
29	F	41	Cholangiocarcinoma of the middle third of the common bile duct	Laparotomy	-
30	F	60	Gallbladder adenocarcinoma (advanced stage)	Laparotomy	Streptococcus sp.

Identified Bacteria	Group 1	Group 2	Total
Escherichia coli	5	0	5
Klebsiella sp.	3	2	5
Enterobacter sp.	2	0	2
Enterococcus sp.	1	0	1
Streptococcus sp.	1	2	3
Nonfermenter GNB	1	0	1
Proteus Vulgaris	1	0	1
Total	14	4	18

GROUPS	N	ASSOCIATED SURGICAL PROCEDURES PERFORMED AFTER BILE COLLECTION AND CHOLECYSTECTOMY
	1	No procedure associated with CCT
	2	No procedure associated with CCT
	3	No procedure associated with CCT
	4	Cyst resection in the common bile duct and intrahepatic biliodigestive anastomosis (hepatic-jejunal)
	5	Choledochotomy + biliodigestive anastomosis (hepatoduodenal)
GROUP 1	6	No procedure associated with CCT
	7	Choledochotomy + biliodigestive anastomosis (choledochusduodenal)
	8	No procedure associated with CCT
	9	No procedure associated with CCT
	10	Choledochotomy, suture of common bile duct and placement of Kehr's drain
	11	No procedure associated with CCT
	12	No procedure associated with CCT
	13	GDP and abdominal cavity draininga
	14	GDP, liver biopsy and abdominal cavity draininga
	15	GDP and abdominal cavity draininga
	16	GDP and abdominal cavity draininga
	17	GDP and abdominal cavity draininga
	18	GDP and abdominal cavity draininga
	19	GDP and abdominal cavity draininga
	20	GDP and abdominal cavity draininga
GROUP 2	21	GDP and abdominal cavity draininga
	22	GDP, liver biopsy and abdominal cavity draininga
	23	GDP and abdominal cavity draininga
	24	GDP and abdominal cavity draininga
	25	GDP and abdominal cavity draininga
	26	GDP and abdominal cavity draininga
	27	GDP and abdominal cavity draininga
	28	GDP and abdominal cavity draininga
	29	Tumor resection in the middle third of the biliary tract
		and biliodigestive anastomosis (choledochojejunostomy)
	30	Resection of the biliary tract and biliodigestive anastomosis
		(choledochojejunostomy)

N	Identified bacteria	Jaundice preoperatively	Comorbidities	Postoperative infectious complications	Hospital stay (in days)
	GROUP 1
1	-	NO	Hypothyroidism	Absent	16
2a	E. coli and Enterococcus sp	NO	Absent	Sepsis by intra-abdominal origin focus	33
3a	Enterobacter spband Nonfermenter GNB	YES	SAH	Absent	53
4a	E. coli and Streptococcus sp	YES	Absent	Absent	11
5a	E. colib	YES	SAH, Diabetes and Depression	Absent	14
6a	-	NO	SAH	Absent	4
7a	Klebsiella spb, E. coli and Proteus Vulgarisb	NO	BPH	Surgical wound infection	9
8a	-	NO	Absent	Absent	9
9a	Enterobacter sp	NO	Absent	Absent	2
10a,c	E. coli and Klebsiella sp	YES	SAH	Absent	9
11a	Klebsiella sp	NO	Diabetes	Absent	3
12a	-	NO	Absent	Absent	8
	GROUP 2
13a	Klebsiella sp	YES	SAH, Diabetes,	UTI	51
14a	-	YES	Absent	Absent	37
15	-	YES	Absent	Absent	37
16	Klebsiella sp	YES	Absent	Absent	21
17	Streptococcus sp	YES	Absent	Undetermined fever	44
18	-	YES	Absent	Absent	19
19a	-	YES	Absent	Absent	15
20	-	NO	SAH	Absent	59
21	-	YES	Absent	Absent	36
22	-	YES	Absent	Absent	58
23	-	YES	SAH and Diabetes	Absent	30
24	-	YES	SAH	Absent	33
25	-	YES	Diabetes	Absent	23
26c	-	YES	Depression	UTI	11
27	-	YES	Absent	Absent	21
28	-	YES	SAH	Undetermined fever	20
29	-	NO	Absent	Absent	13
30	Streptococcus sp	YES	Absent	Undetermined fever	17

Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia e Outras Especialidades - IBEPEGE. Rua Dr. Seng, 320, 01331-020 São Paulo - SP Brasil, Tel./Fax: +55 11 3147-6227 - São Paulo - SP - Brazil
E-mail: secretariaarqgastr@hospitaligesp.com.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: José Roberto Alves. Departamento de Medicina Integrada, Faculdade de Medicina, Universidade Federal do Rio Grande do Norte. Av. Nilo Peçanha, 620.Petrópolis - CEP: 59012-300 - Natal, RN, Brasil. E-mail: joserobertoalves1980@gmail.com