Bacteriologic Studies Of Biliary Tract Infection

Abstract

Results of cultures of intrahepatic bile at the time of percutaneous cholangio-graphy reveal that 64% of patients with partial common duct obstruction due to stricture, choledocholithiasis and bile duct carcinoma have positive bile cultures. Only 10% of patients with complete obstruction secondary to carcinoma of the pancreas or ampulla have positive cultures. Correlating the objective culture and X-ray with the patient''s symptomatology indicates that bacteria in concentrations of 100/ml or more may exist in the presence of obstruction with no symptoms, i.e., chills and fever, referable to their presence. The analogy between cholangitis and pyelonephritis is suggested by the evidence that chills and fever were accompanied by septicemia in 5 patients undergoing percutaneous cholangiography. The same organisms were grown from both blood and the bile aspirate. Asymptomatic bactibilia" is converted to clinically manifest cholangitis by trauma. Disruption of the biliary tract mucosa allows bacteria to enter the blood stream and septicemia instigates the chain of events leading to chills and fever. Cultures of the extrahepatic biliary tract in a small group of patients confirm previous reports indicating that approximately 50% of gallbladders will yield positive cultures in the presence of chronic cholelithiasis and cholecystitis. An unknown percentage of patients with chronic gallbladder disease have clostridia in the gallbladder wall. Rare instances of clostridial gas gangrene follow operations of the gallbladder. Two such cases were presented and briefly discussed. No clostridia were found in 75 cultures of intrahepatic bile.