Correlation between biliary bacteriology and types of gallstones in uncomplicated symptomatic cholelithiasis

The aim of this study was to identify the microflora in the gallbladder of patients undergoing cholecystectomy for different types of gallstones and the antibiotic susceptibility pattern of the isolates. Between January 2005 and December 2008, 136 samples of bile [cholesterol stones (CS)] and 175 pigment stones (PS) were collected from 213 women and 98 men, who were between 18-95 years (median age: 52.5±12.0) by laparoscopic or open cholecystectomy at the University Surgical Unit Duzce in Turkey. The bile samples were aerobically cultured to assess microflora and their antibiotic susceptibility. 210 (54%) of the 311 patients with gallstones had bacterial isolates; 78 isolates (37.2%) were from cholesterol stone-containing bile and 132 isolates (62.8%) from pigment stone-containing bile (P<0.01). The overall bacterial isolates from bile samples revealed Escherichia coli (E. coli) predominantly, followed by Pseudomonas aeruginosa (P. aeruginosa) and Enterococcus spp. In one sample, we found Candida lusitaniae (C. lusitaniae). None of the Gram negative strains were resistant to antibiotics but Gram positive strains were highly resistant to penicillins (100%). Looking at the microflora of the gallbladder and the susceptibility pattern of our isolates, we would suggest that antibiotic prophylaxis recommended for laparoscopic or open cholecystectomy for gallstones be reviewed and the role of bacteribilia in the surgical management of cholelithiasis requires further study.