ORIGINAL PAPERS
The Culture Site of the Gallbladder Affects Recovery of Bacteria in Symptomatic Cholelithiasis

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Evangelos N Manolis1, Dimitrios K Filippou1, Vassilios P Papadopoulos1, Ioannis Kaklamanos2, Theophanis Katostaras3, Efstratios Christianakis1, Gerasimos Bonatsos2, Athanassios Tsakris1

Departments of
1) Basic Sciences,
2) Surgery and
3) Public Health, School of Health Sciences, University of Athens, Athens, Greece

Abstract

Aim. Traditional methods for bile culturing may miss a large number of underlying bacterial infections that could lead to acute or chronic cholecystitis. Aim: to evaluate possible differences regarding the site of material collection and thus to detect the most suitable sample site for gallbladder culture.

Methods. A cohort of 137 patients with symptomatic cholelithiasis was enrolled. After surgical excision of the gallbladder, bile cultures were separately performed from fundus, body and neck. Identification of bacteria as well as computation of mean bacterial concentrations were performed with standard microbiological techniques. Wilcoxon's paired and Chi-square tests were used for comparison between continuous and discrete parameters, respectively.

Results. Thirty-one patients (22.6%) demonstrated at least one positive culture sample. Positivity was 31/31 (100.0%) in neck samples, 20/31 (64.5%) in body and 13/31 (41.9%) in fundus samples (P<0.001). The microorganisms identified were Escherichia coli (14 cases) and Enterococcus faecalis (10 cases), followed by Staphylococcus aureus (3 cases), Pseudomonas aeruginosa, Enterococcus faecium, Enterobacter aerogenes and Enterobacter cloacae (1 case each). Mean bacterial concentrations in positive samples derived from the neck (272.2 ±187.5) were higher (P<0.01) when compared to those derived from both the body (38.2 ±28.7) and the fundus (12.5 ±11.3). Mean bacterial concentrations in positive samples derived from the body were higher (P<0.01) than those derived from the fundus.

Conclusion. The neck of the gallbladder hosts the biggest bacterial load in comparison with the body and the fundus. This difference might be attributed to the presence of Rokitansky-Aschoff sinuses, which is the main histological characteristic of the region.

Key words
Cholelithiasis - bacterial infection - bile.