Correlation of intra-operative bile cultures with septic complications following biliary tract surgery

Background:  Routine intra-operative bile culture during biliary tract surgeries is a common practice among hepatobiliary surgeons. This is based on reports that bactibilia is a predictor of septic complications following these surgeries. This study was aimed at studying the microbiological profile of routine intraoperative bile cultures and correlate with the isolates from septic foci in those undergoing biliary tract surgeries. Methods: A prospective database of all patients who underwent biliary tract surgeries between July2014 to June 2016 was taken up for analysis. Charts were reviewed with special focus on microbiological culture data yielded from both routine bile culture and those from septic complications were recorded and analyzed. Strain typing screening was done by comparing the antibiotic susceptibility profiles of various isolates in each patient. Results:  Of the total one hundred and forty four patients undergoing biliary tract surgery, 46 patients (32%) had a positive bile culture. Of these cultures were positive in 30 out of 32 patients (94%) who had preoperative CBD stent in situ. Bile culture positivity rate was highest with CBD exploration cases and incidence of surgical site infections (SSI) was highest with pancreatoduodenectomy cases. There was no significant association between a positive bile culture and development of surgical site infection (p = 0.09). Conclusions:  There is no significant association of a positive bile culture with risk of surgical site infections in patients undergoing biliary tract surgery. Even in patients with positive bile culture who develop surgical site infections, two third of them are caused by different strains.