Abstract
The purpose of this study was to elucidate the frequency of bacterial infection of intrahepatic bile in relation to biliary tract pathology. Bile was aspirated during percutaneous transhepatic cholangiography, with or without combined biliary tract drainage, and subjected to bacteriological investigations in 295 patients with various hepatobiliary diseases. Bile was infected in 89% of the 92 patients who had high fever and were on antibiotics at the time of study. Positive cultures were obtained in 39% of the patients who were not so ill as to require antibiotics. The overall incidence of biliary infection was 90% in bile duct stones, particularly high in patients with primary intrahepatic stones, regardless of the presence of stones in the common bile duct, and in patients who had dilation of the common bile duct, presumably due to obstructive involvement of the ampulla of Vater.E. coli andKlebsiella were the most frequent among the aerobic species isolated, and mixed infection involving these organisms was common. Anaerobes were much less frequent, always mixed with aerobes, but positive cultures would increase with more rigorous anaerobic conditions for culture. Duodenal fluid collected simultaneously did not always grow the same microorganisms, but showed a 86–87% coincidence with intrahepatic bile in terms of positive or negative cultures. It is recommended that bile be cultured at the time of percutaneous transhepatic cholangiography.
Similar content being viewed by others
References
Okuda K, Tanikawa K, Emura T, Kuratomi S, Jinnouchi S, Urabe K, Sumikoshi T, Kanda Y, Fukuyama Y, Musha H, Mori H, Shimokawa Y, Yakushiji F, Matsuura Y: Nonsurgical, percutaneous transhepatic cholangiography—diagnostic significance in medical problems of the liver. Am J Dig Dis 19:21–36, 1974
Ferrucci JT Jr, Wittenberg J, Sarno RA, Freyfuss JR: Fine needle transhepatic cholangiography: A new approach to obstructive jaundice. Am J Roentgenol 127:403–407, 1976
Ohto M, Ono T, Tsuchiya Y, Saisho H: Cholangiography and Pancreatography. Tokyo, Igaku-Shoin, 1979, pp. 10–16
Glenn F, Moody FG: Intrahepatic calculi. Ann Surg 153:711–723, 1961
Balasegaram M: Hepatic calculi. Ann Surg 175:149–154, 1972
Nakayama F, Furusawa T, Nakama T: Hepatolithiasis in Japan: Present status. Am J Surg 139:216–220, 1980
Keighley MRB, Burdon DW: Identification of bacteria in the bile by duodenal aspiration. World J Surg 2:255–259, 1978
Lennette EH, Balows A, Hausler WJ, Truant JP: Manual of Clinical Microbiology, 3rd ed. Washington, DC, American Society of Microbiology, 1980, pp. 83–375, 397–445
Chetlin SH, Elliott DW: Biliary bacteremia. Arch Surg 102:303–307, 1971
Pyrtek LJ, Bartus SA: An evaluation of antibiotics in biliary tract surgery. Surg Gynecol Obstet 125:101–105, 1967
Mason R: Bacteriology and antibiotic selection in biliary tract surgery. Arch Surg 97:533–537, 1968
Fukunaga FH: Gallbladder bacteriology, histology, and gallstone. Arch Surg 106:169–171, 1973
Cox JL, Helfrich LR, Pass HI, Osterhaut S: The relationship between biliary tract infection and postoperative complications. Surg Gynecol Obstet 146:233–236, 1978
Deliaris PG, Michail PO, Klonis GD, Haritopoulos NC, Golematis BD, Dreiling DA: Biliary bacteriology based on operative bile culture. Am J Gastroenterol 68:51–55, 1977
Flemma RJ, Flint LM, Osterhaut S, Shingleton WW: Bacteriologic studies of biliary tract infection. Ann Surg 166:563–572, 1967
Saik RP, Greenburg AG, Farris JM, Peskin GW: Spectrum of cholangitis. Am J Surg 130:143–150, 1975
Holman JM, Rikkers LF, Moody FG: Sepsis in the management of complicated biliary disorders. Am J Surg 138:809–813, 1979
Hichey EJ, Couper CE: Acute obstructive suppurative cholangitis. Am J Surg 117:62–68, 1969
Anderson RE, Priesley JT: Observations on the bacteriology of choledochal bile. Surg Gynecol Obstet 133:486–489, 1951
Goswitz JT: Bacteria and biliary tract disease. Am J Surg 128:644–646, 1974
Lou MA, Mandel AK, Alexander JL, Thadepalli H: Bacteriology of the human biliary tract and the duodenum. Arch Surg 112:965–967, 1977
Dye M, Macdonald A, Smith G: The bacterial flora of the biliary tract and liver in man. Br J Surg 65:285–287, 1978
Lötveil T, Osnes M, Aune S: Bacteriological studies of common duct bile in patients with gallstone disease and juxta-papillary duodenal diverticula. Scand J Gastroenterol 13:93–95, 1978
Jackman FR, Hilson GRE, Smith of Marlow L: Bile bacteria in patients with benign bile duct stricture. Br J Surg 67:329–332, 1980
Scott AJ, Khan GA: Origin of bacteria in bile duct bile. Lancet 2:790–795, 1967
Scott AJ: Progress report. Bacteria and disease of the biliary tract. Gut 12:487–492, 1971
Silen W, Wertheimer M, Kirchenbaum G: Bacterial contamination of the biliary tree after choledochostomy. Am J Surg 135:325–327, 1978
Elkeles G, Mirrizi L: A study of the bacteriology of the common bile duct in comparison with the other extrahepatic segments of the biliary tract. Ann Surg 116:360–366, 1942
Pridgen JE Jr, Aust JB, McInnis WD: Primary intrahepatic gallstones. Arch Surg 112:1037–1044, 1977
Maki T: Pathogenesis of calcium bilirubinate gallstones: Role ofE. coli, β-glucuronidase and coagulation by inorganic ions, polyelectrolytes and agitation. Ann Surg 164:90–100, 1966
Hess W: Benign stenosis of the papilla of vater.In The Papilla Vateri and its Disease. M Classen, J Geenen, K Kawai (eds). Baden-Baden, Gerhard Witzstock, 1979, pp 22–27
Okuda K, Tsuchiya Y: Percutaneous transhepatic cholangiography in the diagnosis of juxtaampullary lesions.In The Papilla Vateri and its Disease. M Classen, J Geenen, K Kawai (eds). Baden-Baden, Gerhard Witzstock, 1979, pp 83–91
Furey AT: Ascending cholangitis. NY State J Med 66:1299–1303, 1966
Roth P, Cohen S: Cholangitis, a review of the literature with a report of an illustrative case. Am J Gastroenterol 53:154–163, 1970
Dineen P: The importance of the route of infection in experimental biliary tract obstruction. Surg Gynecol Obstet 119:1001–1008, 1964
Shou ST, Gibson JB: Experimental cholangitis and cholelithiasis. Br J Exp Pathol 49:563–573, 1968
Graham EA, Perterman MG: Further observations on the lymphatic origin of cholecystitis, choledochitis and the associated pancreatitis. Arch Surg 4:23–50, 1922
Byrne JJ, Berger RL: The pathogenesis of acute cholecystitis. Arch Surg 81:812–826, 1960
de la Maza LM, Maeim F, Berman LD: The changing etiology of liver abscess. JAMA 227:161–163, 1974
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Suzuki, Y., Kobayashi, A., Ohto, M. et al. Bacteriological study of transhepatically aspirated bile. Digest Dis Sci 29, 109–115 (1984). https://doi.org/10.1007/BF01317050
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01317050