Bacteriology and antimicrobial choice in hepatolithiasis

Background and aims: Hepatolithiasis is prevalent in southeast Asia and pre sents a difficult management problem. Acute repeated episodes of cholangiti s are frequently manifested in patients with hepatolithiasis. Without prope r treatment, such infection can lead to liver abscess, secondary biliary ci rrhosis, portal hypertension, and death from sepsis or hepatic failure. In addition to clearance of the stones and relief of bile stasis either by sur gery or by interventional radiologic manipulation, effective antimicrobial therapy also plays a crucial role in the treatment of patients with hepatol ithiasis. The aim of this study is to clarify the bacteriology in hepatolit hiasis and to provide the information for an appropriate antimicrobial choi ce. Methods: From July 1993 to June 1996, 150 patients with hepatolithiasis und erwent surgical intervention. Bile specimens were routinely obtained by syr inge 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 mo st frequently found were gram-negative bacteria such as Klebsiella sp, Esch erichia coli, and Pseudomonas sp, and the gram-positive Enterococcus sp. Ba cteroides sp were the most frequently found anaerobes. Conclusions: This study demonstrated the close relationship between acute c holangitis in hepatolithiasis and enteric bacteria and also displayed the d etailed antibiotic sensitivity results. Armed with this fruitful informatio n, we believe the antibiotic treatment for acute cholangitis in hepatolithi asis should first aim at enteric bacteria and be adjusted later according t o the results of bacteriologic cultures and clinical situation to achieve a n effective microbial control.