الملخص

Objectives: 1- To identify the bacteria from the gall bladder and stool samples taken during cholecystectomy of patients with acute, and chronic cholecystitis of calculus and acalculus types. 2- To use serological agglutination tests for the diagnosis of typhoid and brucellosis cholecystitis.3- To find out the antibiogram of the isolated bacteria from the different cases.Methods: A prospective case series study was conducted at Al-Jumhori Teaching Hospital, and Ninevah and Al-Zahrawi Private Hospitals during the period from the 1st of October 2003 to the 30th of June 2004. A total of 150 patients undergoing cholecystectomy (134 females and 16 males)were studied. From each patient samples were collected from the gall bladder (bile, tissue biopsy and stone if present),blood for serological tests and stool (from 69/150 patients).Results: Among the gall bladder samples, 101/150 (67.3%) cases showed bacterial growth, the remaining 49 (32.7%) cases had no growth. The bacterial growth was seen among 83.3% and 64.3% of acute and chronic cholecystitis respectively. A single agent per sample was detected in 62.4% of the cases, whereas mixed growth was identified in the remaining 37.6%. The gram-negative bacteria were predominant and represented 86.7% of the isolates,while gram-positive ones were 13.3%. The most common aerobic bacteria isolated were E. coli (19.3%), while anaerobes were detected in only 5.3% of the isolates. The stool cultures showed similar microorganisms to those identified in the gall bladder samples in 74% of cases. In acute cholecyctitis all the gram-negative bacteria were sensitive to ciprofloxacin followed by ceftriaxone (96.5%) and gentamycin (96.5%). In chronic cholecystitis the most effective drug was ciprofloxacin (93.7%) followed by amikacin (82.2%). In both acute and chronic cholecystitis the least effective antibiotic was ampicillin.Typhoid cholecystitis was detected among four cases only, while brucellosis cholecystitis was not observed.Conclusions: The bacteria causing acute and chronic types of cholecystitis are similar and predominantly are gram-negative bacilli. The intestinal origin of these microorganisms suggests ascending infection from the intestine to the biliary tract. Ciprofloxacin is the most effective drug against the isolated bacteria. Keywords: cholecystitis, typhoid- cholecystitis, brucellosis-cholecystitis.