Microbiological Assessment of Bile During Cholecystectomy: Is All Bile Infected?

The Department of Surgery of the West Wales University, published in the September edtion of the Journal of the International Hepato Pancreato Biliary Association (HPB), a very interesting study. The aim was to determine the prevalence of bactibilia in patients undergoing cholecystectomy and to relate the presence or absence of organisms to the preoperative and postoperative course.

A total of 180 patients were collected, all being cholecystectomized during a 5 year period by a same surgeon. Risk factors for bactibilia (acute cholecystitis, common duct stones, emergency surgery, age > 70 years) were documented.

Seventy percent of the patients had complete data. Bacteria were identified in 15,6 % of cases. All patients had at least 1 risk factor. The overall incidence of infective complications was 20%. This study demonstrated that patients with uncomplicated choleclithiasis have aseptic bile. This sugests that use of prophylactic antibiotics should be limited to patients with risk factors for bactibilia.

HPB 2007; 9: 225-228

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ESOT: Approaches to Prevent Indirect Effects of CMV Infection

Dr. Cecilia Söderberg from the Karolinska Institute, Sweden, gave a lecture today at the European Society for Organ Transplantation, regarding the mechanisms by which the CMV leads to its indirect effects. It has been proposed that indirect CMV effects appear as a result of the ability of the virus to influence immunological functions, and hence the virus must replicate in its host.

Viral infection of cells may lead to indirect effects and graft damage by altered expression of growth factors and cytokines, increased antigen processing and presentation associated with the major histocompatibility complex, and up-regulation of pro-inflammatory adhesion molecules in uninfected cells.

Although ganciclovir is effective for the prevention and treatment of CMV disease in transplant patients, the intravenous form is inconvinient for long-term administration and oral ganciclovir has low bioavailability. The oral pro-drug valganciclovir has higher bioavailability.

Prophylaxis is better able to reduce the overall incidences of many of the complications of CMV compared with pre-emptive treatment.

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