Clinico-microbiological analysis of bactibilia isolates in patients of cholecystectomy

Background: The current study determined microbial flora in bile aspirates from patients undergoing cholecystectomy along with antibiotic susceptibility pattern and resistance mechanism viz. extended spectrum β-lactamase (ESBL).Methods: The study included 110 such patients which were divided in three groups as: Group A that included acute cholecystitis with or without cholelithiasis, Group B included chronic cholecystitis with or without cholelithiasis and Group C included other hepatobiliary ailments requiring cholecystectomy viz. gallbladder carcinoma, acute emphysematous gall bladder and mucocele gall bladder. The bile was subjected to complete microbiological and histopathological examination. Antimicrobial susceptibility of the isolates was performed as per CLSI guidelines.Results: Bacteria were recovered from 07 samples (20%) in Group A, 17 (48.57%) in Group B and 11 (31.43%) in Group C. The polymicrobial infection was seen in 04 (11.43%) patients. The most common organisms isolated were Escherichia coli 15 (38.46%), Klebsiella pneumoniae and Pseudomonas aeruginosa 8 (20.51% each). The majority of Enterobacteriaceae isolates were susceptible to piperacillin-tazobactam and carbapenems. The ESBL production was observed in 17 (43.58%) isolates.Conclusions: Therefore, antimicrobial susceptibility of potential causative organisms, presence of resistant strains in bile, the severity of the cholecystitis, and the local susceptibility pattern must be taken into consideration while prescribing antibiotics. A protocol regarding the management of such cases should be formulated based on observations of similar studies.

A comparative study of low concentration of levobupivacaine versus ropivacaine with fentanyl for patient-controlled epidural labour analgesia

>Background and Aims: Lumbar epidural analgesia is considered the modality of choice for labour analgesia. Despite its super analgesia and improved safety profile, it has been associated with maternal adverse effects like higher incidence of instrumental assisted vaginal delivery (AVD) and motor block leading to decreased ambulation. This study was designed to evaluate the efficacy of low concentrations of local anaesthetics (0.1% ropivacaine and 0.1% levobupivacaine) with 2 μg/ml fentanyl as a patient controlled epidural analgesia (PCEA) technique on the incidence of instrumental AVD along with evaluation of obstetric, maternal, and foetal outcomes.Materials and Methods: In this prospective study, 60 labouring parturients were randomly allocated into two equal groups to receive either 0.1% ropivacaine with 2 μg/ml fentanyl or 0.1% levobupivacaine with 2 μg/ml fentanyl as epidural solutions via PCEA pump infusions (4 ml/h) after 15 ml loading dose of the respective solutions. The incidence of instrumental AVD was noted as the primary outcome along with demographic data, maternal and foetal vital parameters, maternal VAS scores, degree of motor blockade and total epidural drug consumption.Results: The incidence of instrumental AVD was found to be 43.3% in the levobupivacaine group and 30% in the ropivacaine group. This difference was not statistically significant. Both the groups were comparable in terms of demographic data, maternal VAS scores, total epidural drug consumption and foetal APGAR scores.Conclusion: The use of newer local anaesthetics (levobupivacaine and ropivacaine) in low concentrations with opioids (fentanyl) as a PCEA technique may offer high maternal satisfaction in terms of quality of pain relief with fewer adverse events like instrumental AVD and adverse foetal outcomes