Bacteriological analysis of bile in acute cholecystitis according to the Tokyo guidelines

• Published in: Journal of hepato-biliary-pancreatic sciences Vol. 19; no. 4; pp. 476 - 486
• Main Authors: Asai, Koji, Watanabe, Manabu, Kusachi, Shinya, Tanaka, Hidenori, Matsukiyo, Hiroshi, Osawa, Akihiro, Saito, Tomoaki, Kodama, Hajime, Enomoto, Toshiyuki, Nakamura, Yoichi, Okamoto, Yasushi, Saida, Yoshihisa, Nagao, Jiro
• Format: Journal Article
• Language: English
• Published: Japan Blackwell Publishing Ltd 01.07.2012; Springer Japan; Wiley Subscription Services, Inc
• Subjects: Abdominal Surgery; acute cholecystitis; Adult; Aged; Aged, 80 and over; antimicrobial therapy; bacteriological analysis; bile; Bile - microbiology; C-Reactive Protein - analysis; Cholecystitis, Acute - microbiology; Female; Gastroenterology; Hepatology; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; ROC Curve; Sensitivity and Specificity; Severity of Illness Index; Surgical Oncology; tokyo guidelines; Antimicrobial therapy; Tokyo guidelines; Acute cholecystitis; Bile; Bacteriological analysis
• ISSN: 1868-6974; 1868-6982
• DOI: 10.1007/s00534-011-0463-9

Background We performed bacteriological analysis of bile in acute cholecystitis (AC) patients graded in severity according to the Tokyo guidelines. Methods We enrolled 163 AC patients in whom bacteriological analysis of bile was performed. Results Significant differences in age (60 vs. 67 years), body temperature (BT) (37.2 vs. 37.6°C), white blood cell count (13,033 vs. 15,177/mm 3 ), and serum C-reactive protein (CRP) (8.9 vs. 16.9 mg/dL) were found between the Mild and Moderate severity groups. The prevalence of bactibilia differed significantly between Mild and Moderate patients (45.3 vs. 67.0%, P  = 0.0107); however, there were no significant differences in the bacterial strains, prevalence of antimicrobial resistance, or polymicrobial isolation frequency between the 2 groups. Our local antibiogram revealed that several microorganisms showed higher resistance rates; these were also isolated even in Mild cases. Advanced age, high BT, high serum CRP, and presence of marked local infection were identified as being significantly associated with high risk of bactibilia. Receiver operating characteristic curve analysis indicated the optimal cutoff value of age to be 65 years, of BT to be 37.5°C, and of serum CRP to be 13.4 mg/dL. Conclusion Adequate broad-spectrum antimicrobial therapy should be administered perioperatively even for Mild patients classified according to the current Tokyo guidelines. These results suggest that more precise severity grades may need to be established, including age and CRP as additional parameters.