Agreement between microscopic examination and bacterial culture of bile samples for detection of bactibilia in dogs and cats with hepatobiliary disease

• Autores: Medora B. Pashmakova, Julie Piccione, Micah A. Bishop, Whitney R. Nelson, Sara D. Lawhon
• Localización: JAVMA: Journal of the American Veterinary Medical Association, ISSN-e 0003-1488, Vol. 250, Nº. 9, 2017, págs. 1007-1013
• Idioma: inglés
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• Resumen

  • OBJECTIVE To evaluate the agreement between results of microscopic examination and bacterial culture of bile samples from dogs and cats with hepatobiliary disease for detection of bactibilia.

    DESIGN Cross-sectional study.

    ANIMALS 31 dogs and 21 cats with hepatobiliary disease for which subsequent microscopic examination and bacterial culture of bile samples was performed from 2004 through 2014.

    PROCEDURES Electronic medical records of included dogs and cats were reviewed to extract data regarding diagnosis, antimicrobials administered, and results of microscopic examination and bacterial culture of bile samples. Agreement between these 2 diagnostic tests was assessed by calculation of the Cohen κ value.

    RESULTS 17 (33%) dogs and cats had bactibilia identified by microscopic examination of bile samples, and 11 (21%) had bactibilia identified via bacterial culture. Agreement between these 2 tests was substantial (percentage agreement [positive and negative results], 85%; κ = 0.62; 95% confidence interval, 0.38 to 0.89) and improved to almost perfect when calculated for only animals that received no antimicrobials within 24 hours prior to sample collection (percentage agreement, 94%; κ = 0.84; 95% confidence interval, 0.61 to 1.00).

    CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that agreement between microscopic examination and bacterial culture of bile samples for detection of bactibilia is optimized when dogs and cats are not receiving antimicrobials at the time of sample collection. Concurrent bacterial culture and microscopic examination of bile samples are recommended for all cats and dogs evaluated for hepatobiliary disease.

    Microscopic examination and bacterial culture of bile samples are common during diagnostic work-up of hepatobiliary disease in small animals.1–4 The importance of detection of bacteria in the bile varies among species. Bile in healthy people and cats is reportedly sterile,5,6 whereas occasional presence of enteric bacteria in the bile of healthy dogs has been reported.7 In clinically ill animals, bactibilia may signify the presence of bacterial cholangitis and warrant therapeutic intervention.

    The hepatobiliary system is equipped with several mechanisms that maintain bile sterility. Antegrade flow of bile and a functional sphincter of Oddi have mechanical functions, whereas the local presence of IgA and bacteriostatic bile salts have immunochemical roles.1 Additionally, tight junctions and Kupffer cells prevent bacterial translocation at the interface between bile and blood in the liver parenchyma. When these mechanisms are disrupted by disease, ascending or hematogenous spread of bacteria into the hepatobiliary tree can occur, resulting in considerable morbidity and death secondary to hepatobiliary sepsis.1 Identification of bactibilia in dogs and cats suspected to have bacterial cholangitis has the potential to affect clinical decisions regarding treatment, particularly when bacterial identification is confirmed by results of culture. Microscopic findings for bile samples can be available on the day of sample collection in facilities where a clinical pathologist is readily available, whereas bacterial culture of bile samples requires 3 to 5 days or longer. Furthermore, inappropriate storage and transport conditions of specimens for bacterial culture can compromise the results. For these reasons, understanding the relationship between detection of bactibilia via microscopy and detection via bacterial culture may be of clinical benefit.

    The primary objective of the study reported here was to evaluate the agreement between results of microscopic examination and bacterial culture for detection of bactibilia by use of bile samples from dogs and cats with hepatobiliary disease that had undergone percutaneous cholecystocentesis for bile sample collection. The secondary objective was to evaluate the agreement between these 2 diagnostic tests in a subset of patients that received no antimicrobial treatment within the 24-hour period prior to bile sample collection.