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Laboratory: Clinical Microbiology
Test Name:
Test Code: WS/WAN
Clinical Information:
Test Indications:
Aid in the diagnosis of biliary tract infections.
Acute infections of the biliary tract (cholecystitis, cholangitis) are frequently associated with obstruction of the flow of bile. Obstruction can result from gallstones, tumors, or surgery/injury related strictures. Cholangitis is typically caused by bacteria ascending the biliary tract or entering the bile duct via the portal system or the lymphatics. Microbes associated with biliary tract infection usually represent the normal intestinal flora. Most frequently recovered organisms include Gram-negative bacteria such as E. coli, Klebsiella spp., Enterobacter spp., and Pseudomonas aeruginosa. Anaerobes (Bacteroides spp., Fusobacterium spp., Clostridium spp.) or Gram-positive cocci such as enterococci, streptococci, and staphylococci are less frequently isolated from clinical specimen.
Investigations for parasitic infections of the biliary tree, such as Clonorchis sinensis, Opisthorchis felineus, Opisthorchis viverrini, Fasciola hepatica, and Ascaris lumbricoides, are referred out to Cadham Provincial Lab.
In the setting for advanced HIV infection and AIDS, Cryptosporidium and Cytomegalovirus (CMV) are common pathogens associated with cholagitis.

Bile fluid may be obtained surgically, endoscopically (ERCP), or percutaneously.
Always submit as much fluid as possible. Never submit a swab dipped into fluid.
Only aseptically collected specimen will be processed for anaerobes.
Indicate pertinent clinical details and antimicrobial therapy on the ordering requisition.
Samples and requisitions must be labeled/completed in accordance with the Shared Health Specimen Acceptance Policy.
Accurate patient identification must be made prior to sample collection. Patient identification should be done in accordance with the site policy.

Patient Preparation Instructions:
The sample must be acquired by using aseptic technique. Sampling of skin surface can introduce colonizing bacteria not involved in the infectious process. Follow protocols outlined by your health facility for this sample type.
Collection Devices:
Blood Culture Bottle (Aerobic, Anaerobic) - if aseptically acquired
Do not submit a swab dipped in fluid.
Specimen Required: Aseptically acquired bile or gall bladder fluid (≥1 mL for bacterial culture) (Adult and Pediatirc)

Ensure samples that are being sent to a referral laboratory are packaged in accordance with Transport of Dangerous Goods recommendations for diagnostic samples
Reference Values:
Aerobes:  No growth.
Anaerobes:  No anaerobes isolated.
A final negative report will be sent after 3-5 days.
See Also:
More Information:
Specimen Handling:
Local: Transport to laboratory immediately (≤15 min at room temperature)
Courier/local storage: ≤24 hrs, store at room temperature.