Bacteriology and antimicrobial choice in hepatolithiasis

Background and aims: Hepatolithiasis is prevalent in southeast Asia and presents a difficult management problem. Acute repeated episodes of cholangitis are frequently manifested in patients with hepatolithiasis. Without proper treatment, such infection can lead to liver abscess, secondary biliary cirrhosis, portal hypertension, and death from sepsis or hepatic failure. In addition to clearance of the stones and relief of bile stasis either by surgery or by interventional radiologic manipulation, effective antimicrobial therapy also plays a crucial role in the treatment of patients with hepatolithiasis. The aim of this study is to clarify the bacteriology in hepatolithiasis and to provide the information for an appropriate antimicrobial choice. Methods: From July 1993 to June 1996, 150 patients with hepatolithiasis underwent surgical intervention. Bile specimens were routinely obtained by syringe aspiration from common bile duct. The syringe was immediately capped, and the bile was subsequently cultured for both aerobes and anaerobes. Results: Bacteria were present in the bile of all patients. The bacteria most frequently found were gram-negative bacteria such as Klebsiella sp, Escherichia coli, and Pseudomonas sp, and the gram-positive Enterococcus sp. Bacteroides sp were the most frequently found anaerobes. Conclusions: This study demonstrated the close relationship between acute cholangitis in hepatolithiasis and enteric bacteria and also displayed the detailed antibiotic sensitivity results. Armed with this fruitful information, we believe the antibiotic treatment for acute cholangitis in hepatolithiasis should first aim at enteric bacteria and be adjusted later according to the results of bacteriologic cultures and clinical situation to achieve an effective microbial control.