Microbiological Diagnosis and Choice of Antibacterialis Therapy of Biliary Tract Infection

Aim. To show the difficulties in identification of pathogenic organisms of catheter-associated biliary infection and to demonstrate the differences in antibiotic sensitivity of microbes in biofilms and planktonic form. Materials and Methods. The patient with pancreatic head pseudocyst complicated by obstructive jaundice underwent
two-stage surgery. Ultrasound-assisted cholecystostomy was performed followed by cholecystectomy. Further there were
pancreatic head resection with cystopancreato- and hepaticojejunal anastomosis on excluded jejunal loop and common bile duct drainage through the cystic duct. The postoperative period was complicated by recurrent cholangitis. We carried out the microbiological analysis of drainage discharge with the assessment of antibiotic sensitivity according to conventional technique. The drainage surface was studied using scanning electron microscopy. Mass spectrometry was applied for microorganisms’ identification. Biofilms were modeled based on isolates obtained from the catheter;
antibiotic sensitivity of microorganisms in biofilm was determined.
Results. Pseudomonas aeruginosa and Candida аlbicans were isolated in the discharge from cystic duct drainage. The biofilm found on drainage surface consisted of Streptococcaceae strains except for those mentioned above. P. aeruginosa strain could not form biofilm, though it could be built in the biofilm formed by C. albicans. P. aeruginosa and C. аlbicans as part of biofilm lost their sensitivity to antimicrobial agents they had when being in plankton. Conclusion. Bile ducts drainage is associated with biofilm formation on catheter surface. Routine microbiological study does not always enable to evaluate the range of microbial pathogens. Traditionally determined antibiotic sensitivity of planktonic forms does not correspond that when microorganisms are in biofilm. External bile draining eliminates
cholestasis rather than bacteriocholia. Adequate treatment of biliary infection should take into consideration all the above mentioned factors; restoration of bile outflow in small intestine is the most important condition 

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