Journal of Gastrointestinal Surgery

, Volume 11, Issue 8, pp 977–984

Gallstones Containing Bacteria are Biofilms: Bacterial Slime Production and Ability to Form Pigment Solids Determines Infection Severity and Bacteremia

  • Lygia Stewart
  • J. McLeod Griffiss
  • Gary A. Jarvis
  • Lawrence W. Way
Article

Abstract

Objective

Gallstone bacteria provide a reservoir for biliary infections. Slime production facilitates adherence, whereas β-glucuronidase and phospholipase generate colonization surface. These factors facilitate gallstone formation, but their influence on infection severity is unknown.

Methods

Two hundred ninety-two patients were studied. Gallstones, bile, and blood (as applicable) were cultured. Bacteria were tested for β-glucuronidase/phospholipase production and quantitative slime production. Infection severity was correlated with bacterial factors.

Results

Bacteria were present in 43% of cases, 13% with bacteremia. Severe infections correlated directly with β-glucuronidase/phospholipase (55% with vs 13% without, P < 0.0001), but inversely with slime production (55 vs 8%, slime <75 or >75, P = 0.008). Low slime production and β-glucuronidase/phospholipase production were additive: Severe infections were present in 76% with both, but 10% with either or none (P < 0.0001). β-Glucuronidase/phospholipase production facilitated bactibilia (86% with vs 62% without, P = 0.03). Slime production was 19 (±8) vs 50 (±10) for bacteria that did or did not cause bacteremia (P = 0.004). No bacteria with slime >75 demonstrated bacteremia.

Conclusions

Bacteria-laden gallstones are biofilms whose characteristics influence illness severity. Factors creating colonization surface (β-glucuronidase/phospholipase) facilitated bacteremia and severe infections; but abundant slime production, while facilitating colonization, inhibited detachment and cholangiovenous reflux. This shows how properties of the gallstone biofilm determine the severity of the associated illness.

Keywords

Gallstone Bacteremia β-Glucuronidase Phospholipase Biofilm Slime Glycocalyx 

Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  • Lygia Stewart
    • 1
    • 2
  • J. McLeod Griffiss
    • 3
    • 4
  • Gary A. Jarvis
    • 3
    • 4
  • Lawrence W. Way
    • 5
  1. 1.Department of Surgery (112)University of California San FranciscoSan FranciscoUSA
  2. 2.Surgical ServiceSan Francisco VA Medical CenterSan FranciscoUSA
  3. 3.Center for ImmunochemistrySan Francisco VA Medical CenterSan FranciscoUSA
  4. 4.Department of Laboratory MedicineUniversity of California, San FranciscoSan FranciscoUSA
  5. 5.4 Koret Way, L-101, Box 0475University of California San FranciscoSan FranciscoUSA

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