Şebnem NERGİZ, Nezahat AKPOLAT, Kadri GÜL

Kolesistektomi yapılan hastaların safra örneklerinin mikrobiyolojik değerlendirilmesi

Kolesistektomi, genel cerrahi kliniklerinde uygulanan en yaygın gastrointestinal operasyonlardan biridir. Bu çalışmada akut veya kronik kolesistit nedeniyle kolesistektomi yapılan hastalardan alınan safra örneklerinde üreyen mikroorganizmaların saptanması ve antibiyotik duyarlılıklarının belirlenmesi amaçlanmıştır. Üreyen aerob bakterilerin identifikasyonu ve antibiyo tik duyarlılıkları Phoenix (Becton Dickinson Diagnostic Instrument Systems, Spark, Md, USA) otomatize sisteminde; anae rob bakterilerin identifikasyonu ise mini API (bioMerioux-Fransa) sisteminde gerçekleştirilmiştir. İncelenen 108 safra örneğinin 36’sında (% 33) üreme saptanmıştır. Bu 36 örneğin 26’sında (% 72) Gram negatif çomaklar (12 Escherichia coli, 8 Klebsiella pneumoniae, 4 Pseudomonas aeruginosa, 2 Enterobacter cloacae); 8’inde (% 22) Gram pozitif koklar (4 koagülaz negatif stafilokok, 2 Enterococcus faecalis, 2 Staphylococcus aureus) ve 2’sinde (% 6) anaerob bakteri (Bacteroides fragilis) üremiştir. Hiçbir örnekte mantar ürememiş ve miks infeksiyon görülmemiştir. İzole edilen Gram negatif bakterilere karşı amikasin (% 100), Gram pozitif bakterilere karşı ise vankomisin (% 100) en etkili antibiyotikler olarak bulunmuştur. Kolesistektomi sırasında alınan örneklerin mikrobiyolojik incelenmesi, post-operatif gelişen infeksiyonların tanı ve tedavisini kolaylaştırmaktadır. Safra kültürünün değerlendirilmesi ve izole edilen etkene uygun antibiyotiğin başlanması tedavi süresini kısaltacaktır.

Microbiological assesment of bile samples of patients who had cholecystectomy

Cholecystectomy is one of the most common gastrointestinal operations performed in general surgical units. The aim of this study was to determine the microorganisms and their antibiotic susceptibilities that were isolated from bile samples of patients who had cholecystectomy because of acute or chronic cholecystitis. The identification and antibiotic susceptibility of the isolated aerobic bacteria were performed by Phoenix (Becton Dickinson Diagnostic Instrument Systems, Spark, Md, USA) automated system and the identification of anaerobic bacteria was performed by mini API (bioMerioux-France) system. Of 108 bile samples examined, 36 (33 %) were culture positive. 26 (72 %) of which were Gram negative bacteria (12 Escherichia coli, 8 Klebsiella pneumoniae, 4 Pseudomonas aeruginosa, 2 Enterobacter cloacae); 8 (22 %) were Gram positive cocci (4 coagulase negative staphylococci, 2 Enterococcus faecalis, 2 Staphylococcus aureus) and 2 (6 %) were anaerobic bac- teria (Bacteroides fragilis). No fungi was isolated and there was no mixed infection. The most effective antibiotics against Gram negative and Gram positive bacteria were amikacin (100 %) and vankomycin (100 %), respectively. The microbiologic examination of the samples obtained during cholecystectomy, facilitates the diagnosis and treatment of post-operative infections. The evaluation of the bile culture and starting the appropriate antibiotic according to the isolated agent will shorten the treatment duration.

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1. Abbasoğlu O. Biliyer sepsisin cerrahi tedavisi, ANKEM Derg 2005;19(Ek 2):50-1.
2. Akhan O. Biliyer sepsiste girişimsel radyolojinin rolü, ANKEM Derg 2005;19(Ek 2):48-9.
3. Al Harbi M, Osoba AO, Mowallad A, Al-Ahmadi K. Tract microflora in Saudi patients with cholelit- hiasis, Trop Med Int Health 2001;6(7):570-4. http://dx.doi.org/10.1046/j.1365-3156.2001. 00748.x PMid:11469952
4. Başaran S, Özsüt H. Safra kesesi ve safra yolları infeksiyonlarına infeksiyolojik yaklaşım, Klimik Derg 2006;19(3):98-103.
5. Chang WT, Lee KT, Wang SR et al. Bacteriology and antimicrobial susceptibility in biliary tract disease: an audit of 10-year’s experience, Kaohsiung J Med Sci 2002;18(5):221-8. PMid:12197428
6. Darko R, Archampong EQ. The microflora of bile in Ghanaians, West Afr J Med 1994;13(2):13-5. PMid:8080823
7. Demirel H, Yıldırımoğlu Ş, Kuşdemir A, Tezel S, Öngeren U. Kolesistektomi olgularında safra kül türlerinin mikrobiyolojik analizi, T Klin J Gastroenterohepatol 2003;14(1):12-6.
8. Den Hoed PT, Boelhouwer RU, Veen HF, Hop WC, Bruining HA. Infections and bacteriological data after laparoscopic and open gallbladder sur gery, J Hosp Infect 1998;39(1):27-37. http://dx.doi.org/10.1016/S0195-6701(98)90240-7
9. Flores C, Maguilnik I, Hadlich E, Goldani LZ. Microbiology of choledochal bile in patients with choledocholithiasis admitted to a tertiary hospital, J Gastroenterol Hepatol 2003;18(3):333-6. http://dx.doi.org/10.1046/j.1440-1746.2003. 02971.x PMid:12603536
10. Fu HQ. Anaerobes in biliary tract infection, Zhonghua Wai Ke Za Zhi 1989;27(8):454-6. PMid:2620596
11. Güdücüoğlu H, Bozkurt H, Bayram Y, Yaman G, Berktaş M. Kolesistektomi yapılan hastaların safra örneklerinden izole edilen mikroorganizmalar ve antibiyotiklere duyarlılıkları, Genel Tıp Derg 2004;14(1):13-7.
12. Kiesslich R, Holfelder M, Will D et al. Interventional ERCP in patients with cholestasis. Degree of bili ary bacterial colonization and antibiotic resistan ce, Z Gastroenterol 2001;39(12):985-92. PMid:11753782
13. Lee CC, Chang IJ, Lai YC, Chen SY, Chen SC. Epidemiology and prognostic determinants of patients with bacteremic cholecystitis or cholangi tis, Am J Gastroenterol 2007;102(3):563-9. http://dx.doi.org/10.1111/j.1572-0241.2007. 01095.x PMid:17335448
14. Lu Y, Xiang TH, Shi JS, Zhang BY. Bile anaerobic bacteria detection and antibiotic susceptibility in patients with gallstone, Hepatobiliary Pancreat Dis Int 2003;2(3):431-4. PMid:14599954
15. Morris-Stiff GJ, O’Donohue P, Ogunbiyi S, Sheridan WG. Microbiological assessment of bile during cholecystectomy: is all bile infected?, HPB (Oxford) 2007;9(3):225-8.
16. Neve R, Biswas S, Dhir V et al. Bile cultures and sensitivity patterns in malignant obstructive jaun dice, Indian J Gastroenterol 2003;22(1):16-8. PMid:12617446
17. Ohdan H, Oshiro H, Yamamoto Y et al. Bacteriological investigation of bile in patients with cholelithiasis, Surg Today 1993;23(5):390-5. http://dx.doi.org/10.1007/BF00309495 PMid:8324331
18. Petakovic G, Korica M, Gavrilovic S. Bacteriologic examination of gallbladder contents, Med Pregl 2002;55(5-6):225-8. http://dx.doi.org/10.2298/MPNS0206225P PMid:12170867
19. Salmanzade Ş, Yönem Ö, Bayraktar Y. Safra taşı hastalığı, Hacettepe Tıp Derg 2006;37(2):65-71.
20. Sattar I, Aziz A, Rasul S, Mehmood Z, Khan A. Frequency of infection in cholelithiasis, J Coll Physicians Surg Pak 2007;17(1):48-50. PMid:17204221
21. Sayek İ. Biliyer sepsis: Fizyopatoloji ve tedavi ilkeleri, ANKEM Derg 2005;19(Ek 2):46-7.
22. Shivaprakasha S, Harish R, Dinesh KR, Karim PM. Aerobic bacterial isolates from choledochal bile at a tertiary hospital, Indian J Pathol Microbiol 2006;49(3):464-7. PMid:17001925
23. Westphal JF, Brogard JM. Biliary tract infections:a guide to drug treatment, Drugs 1999;57(1): 81-91. http://dx.doi.org/10.2165/00003495-199957010- 00007 PMid:9951953