Usefulness of bile cultures and predictive factors for bacteriobilia in percutaneous cholecystostomy in patients with acute cholecystitis

Abstract

BACKGROUND: Bile cultures have been used to diagnose and predict the prognosis of acute cholecystitis (AC). As the standard treatment for AC has changed, the appropriate timing and clinical usefulness of bile cultures should be reevaluated. We analyzed the incidence of positive bile cultures in cholecystostomy and cholecystectomy, and attempted to see if a positive bile culture is related to the laboratory and imaging parameters and postoperative infections. METHODS: Included in the study were 86 patients with AC who underwent percutaneous cholecystostomy (PC) and then laparoscopic cholecystectomy (LC). We performed hematologic, biochemical, and radiological analyses at admission and bile cultures with each surgical procedure. The patients were followed for two months for postoperative infections. RESULTS: Bile cultures were positive in 40.7% of the patients at PC, significantly higher than at LC (12.8%). The group with positive cultures showed a higher median age and elevated levels of alkaline phosphatase (ALP) and total bilirubin (TB) than the group with negative cultures. Univariate analysis identified three preoperative factors as predictors of positive bile cultures: age (>55 yr), ALP (>100 IU/L) and TB (>1.2 mg/dL). Infectious complications after LC were mild and the incidence of postoperative infections was not different between the groups. CONCLUSIONS: The sensitivity of bile cultures is low for diagnosing AC, and the adequate timing of bile cultures is at PC, rather than LC. An old age and factors (ALP & TB) manifesting an advanced stage of bile stasis are associated with positive bile cultures. No correlation was found between positive bile cultures and postoperative infections.