الفهرس 
AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
Gallstone disease is a worldwide problem and remains to be one of the most common
health problems leading to surgical intervention. The association between gallstone disease
and bacteria has been confirmed in many bacteriological studies by scanning electron
microscopy, molecular genetics techniques and bile and gall stones cultures.
The present study aimed to:
1- Identify the bacteria isolated from gallbladder stones and their relative percentage in
cases of cholelithiasis.
2- Determine the antibiogram of the isolated bacterial strains
3- Estimate regimen of antibiotics as per antimicrobial susceptibility results for those
patients undergoing cholecystectomy
The present cross sectional study was carried out over a period of eight months from
January to July 2011 and from February to March 2012. The study was carried out at the
Hepatobiliary and Pancreatic Unit, Surgery Department, Alexandria Main University
Hospital. It involved 80 chronic calcular cholecystitis patients.
The gallstones were collected by the surgeon during cholecystectomy in a sterile
screw capped test tube containing Stuart’s transport medium under complete sterile
conditions. Gall stones were transported within sixty minutes to the Laboratory of
Microbiology at High Institute of Public Health. Gall stones were immersed in70% ethanol
for 10 min for surface disinfection then washed by sterile saline many times to remove any
bactericidal effects of alcohol then bisected at the midpoint. All criteria about stones
physical characteristics and their cross sections were reported under complete sterile
conditions to estimate their type. After that, stones were crushed and mixed with 2 ml of
sterile broth then cultured onto each of blood and MacConkey’s agar plates, aerobically
incubated for 24h at 37°C.
Any isolated organisms were identified by standard microbiological techniques and
tested for their antibiotic susceptibility by disc diffusion method described by Kirby and
Bauer following CLSI guidelines.
The results of this study revealed that:
1. Out of 80 chronic calcular cholecystitis patients who were admitted for
cholecystectomy. 69 (86.25%) were females and 11 (13.75%) were males with mean
age of 40.00 years ± 11.7 years and a female to male ratio of 6.27: 1.
2. Out of 80 patients 83 stones were collected
3. According to their morphological characteristics stones were classified and the most
prevalent stone type was calcium bilirubinate which is known by brown stones
(36.14%) while the least prevalent type was the pure cholesterol stones (13.25%).
4. Stone culture revealed that 55% of the stones were sterile while 45% of the stones
were infected with 39 isolates.
Summary and Conclusions
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5. Out of the 39 isolates, polymicrobial infection occurred in 3 patients (3.75%)
6. Out of the 39 isolates, there were 33(84.6%) Gram negative isolates and 6 (15.4%);
Gram positive isolates.
7. The isolated enteric organisms were 27 (69.23%) while non-enteric organisms were12
(30.77%)
8. The most common bacterial isolate was E.coli representing 11 isolates (28.18%).
9. There was a significant increase in the rate of gallstone infection and age equal to and
above 40 years than those patients below this age (67.65%versus 28.26% respectively).
10. There was no significant increase in gallstone infection among certain gender though
the male to female percentages was 72.72%, 40.58% respectively.
11. There was a significant increase in the incidence of gallstone infection with those
patients harboring calcium bilirubinate stones while, none of the other stone types
showed a significant relation with infection.
12. Susceptibility patterns suggest that piperacillin-tazobactam, meropenem, amikacin,
gentamicin and ceftriaxone would be the most effective antimicrobials for both Gram
positive and negative organisms.
It can be concluded from this study that:
1. The most prevalent stone type was calcium bilirubinate.
2. The most common bacterial isolate was E.coli.
3. There was a significant increase in the occurrence of gallstone infection and the
pigmented calcium bilirubinate stones.
4. Susceptibility patterns suggest that piperacillin-tazobactam, meropenem, amikacin,
gentamicin and ceftriaxone would be the most effective antimicrobials for both Gram
positive and negative organisms.
Recommendations
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RECOMMENDATIONS
from the results of this study, the following recommendations are suggested:
1- Complete retrieval of all stones and debris dropped in the peritoneal cavity during
cholecystectomy especially laparoscopic cholecystectomy is a must.
2- Cultures of the gallstone(s) at the time of cholecystectomy and antibiotic susceptibility
testing of any bacterial growth
3- Prompt administration of appropriate antibiotics to control the biliary tract infection is
important.
4- Continous change in the policy of antibiotics according to the gallstone(s) antibiotic
susceptibility results.