Bile is usually sterile in healthy individuals, however, in the presence of gallstones in the gallbladder or biliary ducts or any cause for obstructive jaundice, it could be colonized with bacteria (bactobilia). Bile duct obstruction leads to increase in intra biliary pressure, infection of bile, cholangiovenous and cholangiolymphatic reflux leading to bacteremia [1]. In addition the jaundice associated with biliary obstruction causes decreased kupffer cell. In the presence of gallstones within gallbladder or the biliary tree, the positive cultures are being increased. The bacteria commonly found in biliary tract infection include Escherichia coli, klebsiella pneumonia, Pseudomonas, Enterococcus [2]. The presence of bacteria in bile (bactibilia) in case of biliary obstruction can progress to cholangitis and septicaemia. Cholangitis is more common in partial biliary obstruction. The frequency of bactibilia, its chances of progressing to clinical cholangitis, the spectrum of bacteria that infect bile and their sensitivity to antibiotics are important for patient management. Bacterial spectrum and antibiotic sensitivity may vary in patients according to etiology of obstruction, concomitant or prior use of antibiotics and prior intervention of biliary system. In some studies, bactobilia has been shown to be a risk factor predisposing to postoperative infectious complications, which are one of the most important concerns of surgeons, especially in laparoscopic surgery [3]. Detecting bactobilia could be valuable for planning the antibiotic prophylaxis and treatment of postoperative infections. Therefore, the aim of this study was to determine the nature of bacteriain bile and their antimicrobial susceptibility in patients with obstructive jaundice

A retrospective study done between the year 2017 and 2018, 30 consecutive patients with obstructive jaundice admitted to the gastroenterology ward of saveetha medical college and hospital were included. Bacteria growing from subcultures were identified by using standard microbiological tests including gram staining and biochemical profiles. Antibacterial susceptibility was determined according to the standard disk diffusion (Kirby-Bauer) method, Antibacterial susceptibility pattern was interpreted, as recommended by clinical laboratory standards institute (CLSI). Patients were stratified in to bile culture positive (B+) and bile culture negative (B-) groups according to the presence and absence of bacteria in bile. Statistical analysis is done using MS Excel

A total of 30 participants, 14 women and 16 men were included. In 30 bile samples collected, 21 samples (70%) were shown to have bacterial isolates and 9(30%) samples showed no bacterial growth. Of the 30 samples studied, 23 had benign disease (cholelithiasis 9, stricture 3, acute calculus cholecystitis 6, gall bladder empyema 4, choledochal cyst 1) and 7 had malignant disease (cholangiocarcinoma 4, gall bladder carcinoma 1, carcinoma of head of pancreas 1, hepatocellular carcinoma 1). Bactibillia is found more often in benign disease than in malignant disease. (Table 1)

Table 1

Bile culture was done in 30 samples and bactibilia detected in 21 samples [70%.] .Most frequently gram negative bacilli were seen (81%). Gram negative bacilli were isolated in 17 samples [81%] and gram positive cocci in 4 samples [19%]. The gram negative organism obtained are E.coli 7 (33%), Pseudomonas 1 (5%), k.pneumoniae 5 (23%), Citrobacter 1(5%), Proteus 1(5%), Acinetobacter 1(5%), Providencia stuartii 1 (5%). The Gram positive organism (19%) obtained are Enterococcus 3 (14%) And Streptococcus 1(5%) (Table 2)

Table 2: showing microorganism isolated from bile

E.coli are commonly found in case of acute calculus cholecystitis, gall bladder empyema and cholangiocarcinoma. K.pneumoniae is mostly found in cholelithiasis (table 3)

Table 3: Comparison of biliary bacterial spectrum in different group of patients

Bacteriological profile of bile culture showed that 4 strains of E.coli and 2 strains of k.pneumoniae were sensitive to Amikacin, Gentamicin. All strains of Gram positive organism were sensitive to Vancomycin. All strains of Pseudomonas and Acinetobacter were sensitive to Polymyxin B. 4 strain of E.coli, 3 strain of k.pneumoniae, all strain of Acinetobacter, Streptococcus were sensitive to piperazillin-tazobactam. Only 1 strain of E.coli and k.pneumoniae were sensitive to Cefepime and Tigecyclin. 4 strain of E.coli, 2 strain of k.pneumoniae and all strains of Proteus, Providencia sp, and Streptococcus were sensitive to Cefotaxime. 2 strains of E.coli and k.pneumoniae were sensitive to Ciprofloxacin. Only 1 strain of k.pneumoniae was sensitive to Streptomycin, Imipenem, Ertapenem, Meropenem, Linezolid. 2 strain of E.coli and all strain of Citrobacter and Proteus were sensitive to Imipenem.. All strain of Streptococcus were sensitive to Ciprofloxacin, Imipenem, Cotrimoxazole, Meropenem, Amoxicillin. Also Only 2 strains of Enterococcus are sensitive to Penicillin (table 4).

Table 4