Isolation and identification of bacteria from patients with cholecystits and cholelithiasis undergoing cholecystectomy

Fourty patients were included in this study, which was extending from April 2008 till October 2008. The patients were attending the Al-Sader Teaching Hospital in Al-Najaf province. They were all undergoing clinically and ultrasound examination. 16 of them were with cholecystits and 24 were with cholelithiasis. 11 were males and 29 were females. The age range was 15-65 years. All patients were undergoing cholecystectomy. Bile fluid and pieces of gallbladder were collected from each patient and cultured on routine bacteriological media. Identification of bacterial growth was based on standard bacteriological criteria. The results revealed thatall patients were culture positive. Escherichia coil represent the most common isolates (75%) in cholecystits, and (79.17%) in cholelithiasis, while β-hemolytic streptococci were found in (12.5%) of cholecystits cases and (8.33%) of cholelithiasis cases. Klebsiella spp. were found in (6.25%) of cholecystits and (12.5%) of cholelithiasis cases. Proteus spp. were isolated from (6.25%) of patients with cholecystits. It can be concluded that the isolation rate of Gram's negative bacteria were higher than that of Gram's positive bacteria from patients with cholecystitis and cholelithiasis undergoing cholecystectomy. Introduction: Cholecystitis refers to a painful inflammation of the gallbladder's wall , that may occur as acute or chronic. Acute cholecystitis is one of the most common and major complication of gallstones (Chatziioannou et al., 2000). Gall stones are solid accumulations of the components of bile , particularly cholesterol , bile pigments and calcium (Irfans etal.,2007). Gallstone disease (Cholelithiasis) remains one of the most common medical problems leading to surgical intervention. Cholelithiasis affects approximately 10% of the adult population in the United States (Schirmer et al., 2005). The gallbladder is often colonized by Salmonella during typhoid fever causing acalculous cholecystitis (Ruiz-Rebollo et al., 2008) . It has been demonstrated that infected gallbladders showed histopathological damage characterized by destruction of the epithelium and massive infiltration of neutrophils, accompanied by a local increase of proinflammatory cytokines (Menendez et al., 2009). Furthermore, Most of the studies have shown a good association of mixed bacterial and Salmonella infections in the carcinogenesis of cancer gallbladder especially in the area of high endemicity of typhoid (Kumar, 2006). In Saudi Arabia, 25% of patients undergoing laparoscopic cholecystectomy for gallstones were bacterial culture positive, and the most common organisms isolated were E. coli (28.1%), E.faecalis (15.6%) and P. aeruginosa (9.4%). No anaerobes were detected, but Candida albicans was isolated in one case (Al Harbi et al., 2001). In another study among patients undergoing cholecystectomy, The overall, bile cultures were positive in 22%. There were 13.3% patients with positive bile from the gallbladder. From the laparoscopically operated patients 2.8% had a positive bile culture. The predominant microorganisms from gallbladder bile were E. coli, Klebsiella spp. and Streptococcus spp. There was no ( دلجملا....................................................ةايحلا مولعل ةفوكلا ةعماج ةلجم 3 ( ددعلا ) 1 ةنسل ) 1111 2 relationship between positive gallbladder cultures and wound infection (Den Hoed et al., 1998). Capoor et al. (2008), in a study to determine the spectrum of biliary microflora in patients with acute cholangitis with and without cholelithiasis or other biliary diseases demonstrated that bacteria were recovered from 32% of patients with cholecystitis with cholelithiasis, 51.4% in patients with acute cholecystitis, and 1.6% in patients with gallbladder carcinoma. The most common organisms isolated were E. coli (29.7%), K. pneumoniae (27%), C. freundii (8.1%), S. enterica serovar Typhi (8.1%). The frequencies of gram-negative aerobic bacteria were high among patients with primary biliary infection, while those of gram-positive aerobic bacteria were high among patients with postoperative biliary infection. Although vancomycinresistant enterococci was not isolated, the frequency of Methicillin-resistant S. aureus was extremely high (Mukaiya et al., 2005). In a study included 68 patients (41 with cholelithiasis and 27 with cholecystits), H.pylori DNA was detected in 15% of the patients in gallbladder tissue specimens, but no clinical correlation with billiary disease could be established (Yucebilgili et al., 2009). Recently, it has been found that PCR is more sensitive in detecting bacterial contamination of gallbladder bile in patients with chronic cholecystits than conventional culture method (Lemos et al., 2010). Materials and Methods: Forty patients were included in this study, which was extending from April 2008 till October 2008. The patients were attending the Al-Sader Teaching Hospital in AlNajaf province. All patients were undergoing cholecystectomy. Bile fluid and pieces of gallbladder were collected aseptically from each patient using sterile universal bottles containing Brain Heart infusion broth as transport media. Specimens were culture on blood agar and MacConkey agar plates as soon as it delivered to the laboratory, and incubated overnight at 37 0 C. Identification of bacterial growth was based on colonial morphology and standard biochemical tests (Collee et al ,1996). Results: They were all undergoing clinically and ultrasound examination. 16 (40%) of them were with cholecystits and 24 (60%) were with cholelithiasis. 11 (27.5%) were males and 29 (72.5%) were females. The age range was 15-65 years. The male patients consist of 5 (12.5%) with cholecystitis and 6 (15%) with cholelithiasis, while the female patients consist of 11(27.5%) with cholecystitis and 18(45%) with cholelithiasis, table (1). Table (1): distribution of clinical cases according to the age and sex of patients. Age Male Female Cholecystitis Cholelithiasis Male Female Male Female