Incidence of bacterobilia in patients with biliary obstruction in a tertiary center.

INTRODUCTION : Bile in individuals with normal biliary tract is sterile. Presence of biliary obstruction leads to bacterial colonisation of bile. Ascending infection from duodenum and or bacterial translocation from portal vein are the likely sources of infection .Increase in the common bile duct pressure due to obstruction in the presence of infected bile promotes bacterial reflux into lymphatics and hepatic sinusoids resulting in cholangitis. OBJECTIVES : Bacterobilia is commonly observed in patients with obstructed biliary system and is usually asymptomatic .Routine bile culture obtained during ERCP can help in predicting dreaded complications like cholangitis .We studied 30 consecutive bile samples and analysed the incidence of bacterobilia comparing benign and malignant etiology. METHODS : 30 Consecutive patients with biliary obstruction who have undergone ERCP at our hospital were studied.Study population included 13 males and 17 females .23 cases were of benign etiology .7 were malignant .After successful biliary cannulation ,bile was obtained and sent for microbiological analysis. RESULTS : Bile cultures were positive in 16 patients .10 of them had benign etiology .6 of them were malignant .Organisms grown are mainly gram negative with Klebsiella in most of them .Response to cephalosporins were good and resistance to ciprofloxacin was observed . CONCLUSIONS : This study confirms the importance of obtaining routine bile sample during ERCP in obstructed biliary system to predict and prevent dreaded complications like cholangitis