Advertisement

Indian Journal of Surgery

, Volume 81, Issue 5, pp 479–484 | Cite as

Bacteriobilia in Hepato-Pancreato-Biliary Surgery: an Enemy or a Friend in Disguise?

  • Rajvilas Narkhede
  • Gunjan DesaiEmail author
  • Prasad Pande
Review Article
  • 11 Downloads

Abstract

Bacterial colonization of bile, known as bacteriobilia, is predisposed by biliary obstruction and/or biliary interventions. It can lead to an increase in postoperative infective complications through impairment of hepatic synthetic and immunological function and breakdown of intestinal mucosal barrier. However, various reports of bacteremia and increase in infective complications have not been translated into increased postoperative morbidity and mortality. Biliary interventions, including preoperative biliary drainage, have been shown to increase the rates of bacteriobilia, and in turn positive biliary cultures. However, the clinical implication of this biliary colonization and strategies to prevent postoperative infective complications are not well understood. Bacteriobilia may be difficult to prevent completely due to its occurrence from non-modifiable risk factors. However, sparing use of biliary interventions and early identification and treatment of bacteriobilia with culture-directed antibiotics can help prevent catastrophic postoperative infective complications. It is necessary for this culture-based practice to become part of a routine protocol, and every step must be taken to prevent bacteriobilia, and thereby avoid postoperative infective complications and optimize patient outcome.

Keywords

Bacteriobilia Bile culture Biliary contamination Preoperative biliary drainage 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

12262_2019_1933_MOESM1_ESM.docx (13 kb)
ESM 1 (DOCX 13 kb)

References

  1. 1.
    Kneuertz P, Pitt H, Bilimoria K, Smiley J, Cohen M, Ko C, Pawlik T (2012) Risk of morbidity and mortality following hepato-pancreato-biliary surgery. J Gastrointest Surg 16(9):1727–1735PubMedGoogle Scholar
  2. 2.
    Ceppa E, Pitt H, House M, Kilbane E, Nakeeb A, Schmidt C, Zyromski N, Lillemoe K (2013) Reducing surgical site infections in hepatopancreatobiliary surgery. HPB 15(5):384–391PubMedGoogle Scholar
  3. 3.
    Hoshino S, Sun Z, Uchikura K, Tsugane K, Ceppa E, Bulkley GB et al Biliary obstruction reduces hepatic killing and phagocytic clearance of circulating microorganisms in rats. J Gastrointest Surg 7(4):497–506PubMedGoogle Scholar
  4. 4.
    Ding JW, Andersson R, Soltesz V, Willén R, Bengmark S (1994) Obstructive jaundice impairs reticuloendothelial function and promotes bacterial translocation in the rat. J Surg Res 57(2):238–245PubMedGoogle Scholar
  5. 5.
    Tomioka M, Iinuma H, Okinaga K (2000) Impaired Kupffer cell function and effect of immunotherapy in obstructive jaundice. J Surg Res 92(2):276–282PubMedGoogle Scholar
  6. 6.
    Fathi A, Jackson T, Barati M, Eghbalieh B, Siegel K, Siegel C (2016) Extended perioperative antibiotic coverage in conjunction with intraoperative bile cultures decreases infectious complications after pancreaticoduodenectomy. HPB Surg 2016:1–6Google Scholar
  7. 7.
    Sourrouille I, Gaujoux S, Lacave G, Bert F, Dokmak S, Belghiti J, Paugam-Burtz C, Sauvanet A (2013) Five days of postoperative antimicrobial therapy decreases infectious complications following pancreaticoduodenectomy in patients at risk for bile contamination. HPB [Oxford] 15(6):473–480Google Scholar
  8. 8.
    Ghahramani L, Jahromi M, Pouladfar G, Safarpour A, Hosseini S, Aminshahidi M (2017) Bactobilia among patients with uncomplicated cholelithiasis undergoing laparoscopic cholecystectomy: the risk factors and effects on postoperative infectious complications. Annals of Colorectal Research.  https://doi.org/10.5812/acr.12795
  9. 9.
    Csendes A, Burdiles P, Maluenda F, Diaz JC, Csendes P, Mitru N (1996) Simultaneous bacteriologic assessment of bile from gallbladder and common bile duct in control subjects and patients with gallstones and common duct stones. Arch Surg 131(4):389–394PubMedGoogle Scholar
  10. 10.
    Kaya M, Beştaş R, Bacalan F, Bacaksız F, Arslan EG, Kaplan MA (2012) Microbial profile and antibiotic sensitivity pattern in bile cultures from endoscopic retrograde cholangiography patients. World J Gastroenterol 18(27):3585–3589PubMedPubMedCentralGoogle Scholar
  11. 11.
    Csendes A, Mitru N, Maluenda F, Diaz JC, Burdiles P, Csendes P et al Counts of bacteria and pyocites of choledochal bile in controls and in patients with gallstones or common bile duct stones with or without acute cholangitis. Hepatogastroenterology 43(10):800–806Google Scholar
  12. 12.
    Yu H, Guo Z, Xing W, Guo X, Liu F, Li B (2012) Bile culture and susceptibility testing of malignant biliary obstruction via PTBD. Cardiovasc Intervent Radiol 35(5):1136–1144PubMedGoogle Scholar
  13. 13.
    Mandryka Y, Klimczak J, Duszewski M, Kondras M, Modzelewski B (2006) Bile duct infections as a late complication after endoscopic sphincterotomy. Pol Merkur Lekarski 21(126):525–527PubMedGoogle Scholar
  14. 14.
    Munro R, Sorrell TC (1986) Biliary sepsis. Reviewing treatment options. Drugs. 31(5):449–454PubMedGoogle Scholar
  15. 15.
    Isla AM, Griniatsos J, Riaz A, Karvounis E, Williamson RCN (2007) Pancreaticoduodenectomy for periampullary malignancies: the effect of bile colonization on the postoperative outcome. Langenbeck's Arch Surg 392(1):67–73Google Scholar
  16. 16.
    Sung JY, Costerton JW, Shaffer EA (1992) Defense system in the biliary tract against bacterial infection. Dig Dis Sci. Kluwer Academic Publishers-Plenum Publishers; 37(5):689–96Google Scholar
  17. 17.
    Park S-Y, Park C-H, Cho S-B, Lee W-S, Kim J-C, Cho C-K, Joo YE, Kim HS, Choi SK, Rew JS (2011) What is appropriate procedure for preoperative biliary drainage in patients with obstructive jaundice awaiting pancreaticoduodenectomy? Surg Laparosc Endosc Percutan Tech 21(5):344–348PubMedGoogle Scholar
  18. 18.
    Koivusalo A, Mäkisalo H, Talja M, Siitonen A, Vuopio-Varkila J, Ruutu M, Höckerstedt K (1996) Bacterial adherence and biofilm formation on latex and silicone T-tubes in relation to bacterial contamination of bile. Scand J Gastroenterol 31(4):398–403PubMedGoogle Scholar
  19. 19.
    Howard TJ, Yu J, Greene RB, George V, Wairiuko GM, Moore SA et al (2006) Influence of bactibilia after preoperative biliary stenting on postoperative infectious complications. J Gastrointest Surg 10(4):523–531PubMedGoogle Scholar
  20. 20.
    Hochwald SN, Burke EC, Jarnagin WR, Fong Y, Blumgart LH (1999) Association of preoperative biliary stenting with increased postoperative infectious complications in proximal cholangiocarcinoma. Arch Surg 134(3):261–266PubMedGoogle Scholar
  21. 21.
    Rerknimitr R, Fogel EL, Kalayci C, Esber E, Lehman GA, Sherman S (2002) Microbiology of bile in patients with cholangitis or cholestasis with and without plastic biliary endoprosthesis. Gastrointest Endosc 56(6):885–889PubMedGoogle Scholar
  22. 22.
    Scott-Conner CE, Grogan JB (1994) The pathophysiology of biliary obstruction and its effect on phagocytic and immune function. J Surg Res 57(2):316–336PubMedGoogle Scholar
  23. 23.
    Flores C, Maguilnik I, Hadlich E, Goldani LZ. Microbiology of choledochal bile in patients with choledocholithiasis admitted to a tertiary hospital. J Gastroenterol Hepatol 2003 18[3]:333–336PubMedGoogle Scholar
  24. 24.
    Karpel E, Madej A, Bułdak Ł, Duława-Bułdak A, Nowakowska-Duława E, Łabuzek K et al (2011) Bile bacterial flora and its in vitro resistance pattern in patients with acute cholangitis resulting from choledocholithiasis. Scand J Gastroenterol 46(7–8):925–930PubMedGoogle Scholar
  25. 25.
    Salvador VBDG, Lozada MCH, Consunji RJ (2011) Microbiology and antibiotic susceptibility of organisms in bile cultures from patients with and without cholangitis at an Asian Academic Medical Center. Surg Infect 12(2):105–111Google Scholar
  26. 26.
    Kiesslich R, Holfelder M, Will D, Hahn M, Nafe B, Genitsariotis R et al (2001) Interventional ERCP in patients with cholestasis. Degree of biliary bacterial colonization and antibiotic resistance. Z Gastroenterol 39(12):985–992PubMedGoogle Scholar
  27. 27.
    Lorenz R, Herrmann M, Kassem AM, Lehn N, Neuhaus H, Classen M (1998) Microbiological examinations and in-vitro testing of different antibiotics in therapeutic endoscopy of the biliary system. Endoscopy. 30(8):708–712PubMedGoogle Scholar
  28. 28.
    Rösch T, Triptrap A, Born P, Ott R, Weigert N, Frimberger E, Allescher HD, Classen M, Kamereck K (2003) Bacteriobilia in percutaneous transhepatic biliary drainage: occurrence over time and clinical sequelae. A prospective observational study. Scand J Gastroenterol 38(11):1162–1168PubMedGoogle Scholar
  29. 29.
    Itoh N, Kawamura I, Tsukahara M, Mori K, Kurai H (2016) Evaluation of Streptococcus pneumoniae in bile samples : a case series review. J Infect Chemother Elsevier Ltd; 2–5Google Scholar
  30. 30.
    Sakata J, Shirai Y, Tsuchiya Y, Wakai T, Nomura T, Hatakeyama K (2009) Preoperative cholangitis independently increases in-hospital mortality after combined major hepatic and bile duct resection for hilar cholangiocarcinoma. Langenbeck's Arch Surg 394(6):1065–1072Google Scholar
  31. 31.
    Park JW, Lee JK, Lee KT, Lee KH, Sung YK, Kang C-I (2014) How to interpret the bile culture results of patients with biliary tract infections. Clin Res Hepatol Gastroenterol 38(3):300–309PubMedGoogle Scholar
  32. 32.
    Qiu Y-D, Bai J-L, Xu F-G, Ding Y-T (2011) Effect of preoperative biliary drainage on malignant obstructive jaundice: a meta-analysis. World J Gastroenterol 17(3):391–396PubMedPubMedCentralGoogle Scholar
  33. 33.
    Pisters PW, Hudec WA, Hess KR, Lee JE, Vauthey JN, Lahoti S et al (2001) Effect of preoperative biliary decompression on pancreaticoduodenectomy-associated morbidity in 300 consecutive patients. Ann Surg 234(1):47–55PubMedPubMedCentralGoogle Scholar
  34. 34.
    Barreto SG, Singh A, Perwaiz A, Singh T, Singh MK, Sharma S. (2017) Perioperative antimicrobial therapy in preventing complications following pancreatoduodenectomy infectious. [October]:514–9Google Scholar
  35. 35.
    Olsson G, Frozanpor F, Lundell L, Enochsson L, Ansorge C, Chiaro M Del, et al. Preoperative biliary drainage by plastic or self-expandable metal stents in patients with periampullary tumors : results of a randomized clinical study Authors. 2017;798–808Google Scholar
  36. 36.
    Jagannath P, Dhir V, Shrikhande S, Shah RC, Mullerpatan P, Mohandas KM (2005) Effect of preoperative biliary stenting on immediate outcome after pancreaticoduodenectomy. Br J Surg 92(3):356–361PubMedGoogle Scholar
  37. 37.
    Singhirunnusorn J, Roger L, Chopin-Laly X, Lepilliez V, Ponchon T, Adham M. Value of preoperative biliary drainage in a consecutive series of resectable periampullary lesions. From randomized studies to real medical practice. Langenbecks Arch Surg. 2013 398[2]:295–302PubMedGoogle Scholar
  38. 38.
    Sohn TA, Yeo CJ, Cameron JL, Pitt HA, Lillemoe KD Do preoperative biliary stents increase postpancreaticoduodenectomy complications? J Gastrointest Surg 4(3):258–267 discussion 267-8PubMedGoogle Scholar
  39. 39.
    Mezhir JJ, Brennan MF, Baser RE, D’Angelica MI, Fong Y, DeMatteo RP et al (2009) A matched case-control study of preoperative biliary drainage in patients with pancreatic adenocarcinoma: routine drainage is not justified. J Gastrointest Surg 13(12):2163–2169PubMedGoogle Scholar
  40. 40.
    di Mola FF, Tavano F, Rago RR, De Bonis A, Valvano MR, Andriulli A et al (2014) Influence of preoperative biliary drainage on surgical outcome after pancreaticoduodenectomy: single centre experience. Langenbeck's Arch Surg 399(5):649–657Google Scholar
  41. 41.
    Limongelli P, Pai M, Bansi D, Thiallinagram A, Tait P, Jackson J, Habib NA, Williamson RCN, Jiao LR (2007) Correlation between preoperative biliary drainage, bile duct contamination, and postoperative outcomes for pancreatic surgery. Surgery. 142(3):313–318PubMedGoogle Scholar
  42. 42.
    Grizas S, Stakyte M, Kincius M, Barauskas G, Pundzius J (2005) Etiology of bile infection and its association with postoperative complications following pancreatoduodenectomy. Medicina [Kaunas] 41(5):386–391Google Scholar
  43. 43.
    Guglielminetti D, Campanini A, Gardini G, Alberti L, Poddie D The correlation of bacteriobilia/wound infections in elective biliary surgery. G Chir 12(1–2):34–36Google Scholar
  44. 44.
    Povoski S, Karpeh M, Conlon K, Blumgart L, Brennan M (1998) Positive intraoperative bile cultures at the time of pancreaticoduodenectomy are associated with preoperative biliary drainage and subsequent development of postoperative infectious complications and mortality. Gastroenterology 114:A537Google Scholar
  45. 45.
    Cortes A, Sauvanet A, Bert F, Janny S, Sockeel P, Kianmanesh R, Ponsot P, Ruszniewski P, Belghiti J (2006) Effect of bile contamination on immediate outcomes after pancreaticoduodenectomy for tumor. J Am Coll Surg 202(1):93–99PubMedGoogle Scholar
  46. 46.
    Sarac F, Salman T, Gun F, Celik A, Gurler N, Dogru Abbasoglu S et al (2015) Effect of probiotic supplementation on bacterial translocation in common bile duct obstruction. Pediatr Surg Int 31(2):155–161PubMedGoogle Scholar
  47. 47.
    Margaritis VG, Filos KS, Michalaki MA, Scopa CD, Spiliopoulou I, Nikolopoulou VN, Vagianos CE (2005) Effect of oral glutamine administration on bacterial tanslocation, endotoxemia, liver and ileal morphology, and apoptosis in rats with obstructive jaundice. World J Surg 29(10):1329–1334PubMedGoogle Scholar
  48. 48.
    Zulfikaroglu B, Zulfikaroglu E, Ozmen MM, Ozalp N, Berkem R, Erdogan S et al (2003) The effect of immunonutrition on bacterial translocation, and intestinal villus atrophy in experimental obstructive jaundice. Clin Nutr 22(3):277–281PubMedGoogle Scholar
  49. 49.
    Onder A, Kapan M, Yuksel H, Tekin R, Kele A, Evliyaoglu O et al The effects of erythropoietin on bacterial translocation and inflammation in rats with obstructive jaundice. Ann Ital Chir 85(2):159–165Google Scholar
  50. 50.
    Scopa CD, Koureleas S, Tsamandas AC, Spiliopoulou I, Alexandrides T, Filos KS, Vagianos CE (2000) Beneficial effects of growth hormone and insulin-like growth factor I on intestinal bacterial translocation, endotoxemia, and apoptosis in experimentally jaundiced rats. J Am Coll Surg 190(4):423–431PubMedGoogle Scholar

Copyright information

© Association of Surgeons of India 2019

Authors and Affiliations

  1. 1.Department of Gastrointestinal SurgeryDr. Balabhai Nanavati Superspeciality HospitalNavi MumbaiIndia
  2. 2.Department of Gastrointestinal SurgeryLilavati Hospital and Research CenterMumbaiIndia

Personalised recommendations