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RESUMEN Introducción La colecistitis constituye una importante causa de ingreso hospitalario. En colecistitis moderada o severa, el retraso en el tratamiento puede acarrear complicaciones graves. Nuestro objetivo es analizar los microorganismos aislados en bilis de pacientes colecistectomizados y su patrón de sensibilidad para evaluar el tratamiento empírico en aquellos casos en que la extirpación quirúrgica de la vesícula deba demorarse. Pacientes y métodos Estudio descriptivo prospectivo de los cultivos biliares de pacientes sometidos a colecistectomía desde mayo de 2013 hasta febrero de 2015, en el Servicio de Cirugía del Hospital General Universitario de Castellón. Resultados Se estudiaron 196 pacientes, 83 mujeres (42,3%) y 113 hombres (57,7%), con una media de edad de 61,5 años. Los antibióticos más utilizados como tratamiento empírico fueron piperacilina/tazobactam (77,8%) y amoxicilina/clavulánico (14,8%). En el 46,4% de los pacientes (91/196) los cultivos de bilis fueron positivos. Se aislaron un total de 165 microorganismos. La mayoría eran bacilos gramnegativos (60,5%), principalmente Enterobacterales (91/54,5%), siendo Escherichia coli el microorganismo más frecuente (24%) seguido de Klebsiella spp. (12,5%). Se aislaron 3 E. coli productoras de betalactamasa de espectro extendido (BLEE) y 1 Klebsiella pneumoniae BLEE. No se aislaron microorganismos productores de carbapenemasa ni Staphylococcus aureus resistente a meticilina. Conclusión La microbiota biliar, con predominio de Enterobacterales, es similar a la encontrada en estudios europeos.

BackgroundThe pathogenesis of choledocholithiasis is closely related to the role of bacteria. However, little is known about the predictive role of bile bacteria in clinical conditions of patients and the compositional and functional characteristics of biliary microbiota in choledocholithiasis.MethodsTo investigate the predictive value of biliary bacteria, clinical data of 488 patients with choledocholithiasis were collected. The predictive value of common bile bacteria to patients’ clinical conditions was analyzed by logistic regression. Samples of bile and corresponding duodenal juice from 10 selected patients with choledocholithiasis were obtained, and the composition and function of microbial communities were analyzed based on 16S rRNA sequencing and Tax4Fun.ResultsThe clinical conditions of patients with choledocholithiasis, such as recurrence, the severity of acute cholangitis, and duration of hospital stay were closely related to different species of bile bacteria as well as antimicrobial-resistant bacteria. Employing 16S rRNA sequencing, the dominant phyla of biliary and duodenal microbiota were Proteobacteria and Firmicutes. The top three core microbiota at the genus level were Escherichia–Shigella, Fusobacterium, and Enterococcus. Escherichia coli accounted for the most abundant annotated species in both. Differences in composition between biliary and duodenal microbiota were not significant according to the alpha and beta diversities. Differential abundant features were not found in biliary microbiota indicated by A linear discriminant analysis effective size algorithm. The major pathways identified in biliary and duodenal microbiota were related to membrane transport, translation, replication and repair, carbohydrate and amino acid metabolism. However, no significant difference in those major pathways, as well as antimicrobial-resistance patterns, was observed between biliary and duodenal microbiota.ConclusionOur study first demonstrates the predictive contribution of biliary bacteria to the clinical conditions of patients with choledocholithiasis, and then it offers new insights into the compositional and functional features of biliary and duodenal microbiota. Similarities between biliary and duodenal microbiota support the theory of bacterial duodenal–biliary reflux in patients with choledocholithiasis. Meanwhile, when it is impracticable to obtain a bile sample, duodenal juice may be used as an alternative for bacterial culture and susceptibility tests.

The biliary microbiota is related to the pathogenesis of human bile duct stones. However, the extent to which a history of invasive endoscopic sphincterotomy (EST) affects the biliary bacterial community remains largely unknown. We collected bile samples from the common bile duct of 100 choledocholithiasis patients. We performed 16S rRNA sequencing to investigate and compare the biliary microbial community. The patients without antibiotic treatment (AT) were grouped into three clusters based on their biliary microbial compositions. The patients with a history of EST were significantly enriched in one cluster mainly consisting of gastrointestinal bacteria compared with the other two clusters consisting of oral and environmental bacteria. The β-diversities of patients with and without EST were also significantly different, whereas the α-diversities were comparable. The only significantly enriched bacterial genus associated with a history of EST was Pyramidobacter, while eight other genera were significantly decreased. For patients with AT, seven of these genera maintained their association with EST, including Pyramidobacter. However, after AT, the difference in β-diversities was diminished. EST induced a marked shift in the biliary microbial composition. A cluster of biliary bacteria was associated with a history of EST, and Pyramidobacter was specific to EST.

Introduction. Cholecystitis is an important cause of hospital admission. In moderate or severe cholecystitis, the delay in treatment can lead to serious complications. Our objective is to analyze the microorganisms isolated in bile from cholecystectomized patients and their sensitivity pattern, to evaluate the empirical treatment in those cases in which the surgical removal of the gallbladder should be delayed. Patients and methods. Prospective descriptive study of biliary cultures of patients undergoing cholecystectomy from May 2013 to February 2015, in the Surgery Department of the Hospital General Universitari de Castello. Results. We studied 196 patients, 83 women (42.3%) and 113 men (57.7%), with an average age of 61.5 years. The most used antibiotics as empiric treatment were piperacillin/tazobactam (77.8%) and amoxicillin/clavulanic (14.8%). In 46.4% of patients (91/196) bile cultures were positive. 165 microorganisms were isolated. The majority were Gram-negative bacilli (60.5%), mainly of the Enterobacterales order (91/54.5%), with Escherichia coli being the most frequent microorganism (24%) followed by Klebsiella spp. (12.5%). 3 E. coli with extended-spectrum beta-lactamase (ESBL) and 1 K. pneumoniae with ESBL were isolated. Microorganisms producing carbapenemase and methicillin-resistant Staphylococcus aureus were not isolated. Conclusion. The bile microbiota, with a predominance of Enterobacterales is similar to that found in european studies.

Recent dietary habits and lifestyle could explain the shaping of the gut microbiota composition and, in consequence, the increasing prevalence of certain pathologies. However, little attention has been paid to the influence of diet on microbiotas, other than the gut microbiota. This is important in cholelithiasis, given that changes in the production of bile acids may affect gallbladder microbial communities. Our aim was to assess the association between regular dietary intake and gallbladder microbial composition. Fourteen adults with cholelithiasis and 14 controls, sex-age-matched and without gastrointestinal pathology, were included. Diet was assessed through a food frequency questionnaire and quantification of gallbladder microbiota sequences by Illumina 16S rRNA gene-based analysis. The cholelithiasic patients showed greater intake of potatoes and lower consumption of vegetables, non-alcoholic drinks, and sauces, which resulted in a lower intake of energy, lipids, digestible polysaccharides, folate, calcium, magnesium, vitamin C, and some phenolic compounds. Regarding the altered bile microorganisms in cholelithiasic patients, dairy product intake was negatively associated with the proportions of Bacteroidaceae and Bacteroides, and several types of fiber, phenolics, and fatty acids were linked to the abundance of Bacteroidaceae, Chitinophagaceae, Propionibacteraceae, Bacteroides, and Escherichia-Shigella. These results support a link between diet, biliary microbiota, and cholelithiasis., This research was funded by the Spanish “Plan Estatal de I+D+i” Grant number (AGL2013-44761-P) I. Gutiérrez-Díaz was supported by “Plan Regional de Investigación del Principado de Asturias” Grant number (GRUPIN14-043).

Traditionally, the biliary tract has been considered to be normally sterile, and the presence of microorganisms in bile is a marker of a pathological process. This assumption was confirmed by failure in allocation of bacterial strains from the normal bile duct. The paper provides rationale for a phenomenon of the normal biliary microbiota as a separate functional layer which protects a biliary tract from colonization by exogenous microorganisms. We revealed the potential of metagenomic data for prevention of infectious diseases, post-operative complications of reconstructive interventions including bile duct stenting and implantation the tissue-engineered structures exposed to the risks of colonization with pathogenic / exogenous microorganisms. The methods based on preserving homeostasis of normal biliary microbiota ecosystem can be used for prevention of hepatobiliary diseases and treatment of biliary tract inflammatory diseases.

International audience; Traditionally, the biliary tract has been considered to be normally sterile, and the presence of microorganisms in bile is a marker of a pathological process. This assumption was confirmed by failure in allocation of bacterial strains from the normal bile duct. The paper provides rationale for a phenomenon of the normal biliary microbiota as a separate functional layer which protects a biliary tract from colonization by exogenous microorganisms. We revealed the potential of metagenomic data for prevention of infectious diseases, post-operative complications of reconstructive interventions including bile duct stenting and implantation the tissue-engineered structures exposed to the risks of colonization with pathogenic / exogenous microorganisms. The methods based on preserving homeostasis of normal biliary microbiota ecosystem can be used for prevention of hepatobiliary diseases and treatment of biliary tract inflammatory diseases.; Traditionnellement, les voies biliaires ont été considérées comme normalement stériles, et la présence de micro-organismes dans la bile est un marqueur d'un processus pathologique. Cette hypothèse a été confirmée par l'échec de l'allocation des souches bactériennes du canal biliaire normal. L'article fournit la justification d'un phénomène du microbiote biliaire normal en tant que couche fonctionnelle séparée qui protège un tractus biliaire de la colonisation par des micro-organismes exogènes. Nous avons révélé le potentiel des données métagénomiques pour la prévention des maladies infectieuses, les complications postopératoires des interventions de reconstruction, y compris l'endoprothèse des voies biliaires et l'implantation des structures génétiquement modifiées exposées aux risques de colonisation par des micro-organismes pathogènes / exogènes. Les méthodes basées sur la préservation de l'homéostasie de l'écosystème du microbiote biliaire normal peuvent être utilisées pour la prévention des maladies hépatobiliaires et le traitement des maladies inflammatoires des voies biliaires.; Традиционно считалось, что желчный проток стерилен, а присутствие в желчи микроорганизмов является маркером патологического процесса. Подобное предположение подтверждалось безуспешностью выделения бактериальных штаммов из нормального желчного протока. В настоящей работе приводится обоснование феномена нормальной микробиоты желчевыводящих путей как отдельного слоя, который защищает желчные пути от колонизации экзогенными микроорганизмами. Раскрывается возможное использование метагеномных данных для профилактики инфекционных заболеваний и послеоперационных осложнений при реконструктивных вмешательствах. Методы сохранения гомеостаза экосистемы нормальной билиарной микробиоты могут быть использованы для предотвращения гепатобилиарных заболеваний и лечения воспалительных заболеваний желчевыводящих путей.