Microbiological profile of bile in patients undergoing endoscopic retrograde

cholangiography.

Background : Bile is a sterile sample. The bacterial colonization occurs in clinical

conditions such as cholelithiasis , biliary strictures and cholangiopathies . The typical

biliary pathogens are gram negative organisms like Escherichia coli, Klebsiella

species and Pseudomonas aeruginosa . Helicobacter pylori is an important cause of

cholelithiasis . There is a need for empirical and prophylactic antimicrobial therapy in

clinical setting due to emergence of multidrug resistant organisms .The objectives of

this study were determining the bacteriological profile of bile and studying the

antibiotic susceptibility pattern of biliary pathogens.

Methodology : This is a prospective study carried out in the gastro enterology

department of a tertiary care hospital on 50 patients of hepatic infections undergoing

endoscopic retrograde cholangiopancreatography (ERCP) . Bile samples were

collected by ERCP procedure and transported to the microbiology laboratory in

trypticase soy broth. After inoculation on the basal media , the pathogens were be

identified by standard microbiological techniques . Each isolate was subjected to

antimicrobial susceptibility test as per CLSI 2023 guidelines.

Results: Gram-negative bacilli were the predominant organisms isolated with

Escherichia coli (n=19) and Pseudomonas aeruginosa (n=10) . 9 strains of E coli

and 3 strains of Klebsiella pneumoniae produced ESBL. The most sensitive

antibiotics were piperacillin-tazobactam and meropenem.

Conclusion: Cholestasis leads to bacterial colonization . Most of the commonly used

antibiotics have significant sensitivity and can be used empirically.

Keywords: Bile ; Cholelithiasis ; Multi drug resistance ; Cholestasis.; ESBL.