Background

Bile cultures are often sent with blood cultures in patients with acute bacterial cholangitis.

Aims

To assess the yield of blood and bile cultures in patients with cholangitis and the clinical utility of bile cultures in guiding therapy.

Methods

All patients diagnosed with cholangitis, based on the Tokyo 2013/2018 guidelines were recruited retrospectively over ten years. The clinical and investigation details were recorded. The results of bile and blood cultures including antibiotic sensitivity patterns were noted. The concordance of microorganisms grown in blood and bile cultures and their sensitivity pattern were assessed.

Results

A total of 1063 patients with cholangitis were included. Their mean age was 52.7 ± 14 years and 65.4% were males. Blood cultures were positive in 372 (35%) patients. Bile culture was performed in 384 patients with 84.4% being positive, which was significantly higher than the yield of blood culture (p < 0.001). Polymicrobial growth was more in bile (59.3%) than in blood cultures (13.5%, p < 0.001). E.coli, Klebsiella, Enterococcus and Pseudomonas were the four most common organisms isolated from both blood and bile. Extended spectrum betalactamase producing organisms were isolated in 57.7% and 58.8% of positive blood and bile cultures, respectively. Among 127 patients with both blood and bile cultures positive, complete or partial concordance of organisms was noted in about 90%.

Conclusion

Bile and blood cultures have a similar microbial profile in most patients with cholangitis. As bile cultures have a significantly higher yield than blood cultures, they could effectively guide antimicrobial therapy, especially in those with negative blood cultures.

Graphical Abstract

中文翻译：

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胆汁培养可指导急性细菌性胆管炎的抗生素管理

背景

对于急性细菌性胆管炎患者，胆汁培养物通常与血培养物一起送出。

目标

评估胆管炎患者的血液和胆汁培养物的产量以及胆汁培养物在指导治疗中的临床效用。

方法

根据东京 2013/2018 年指南，回顾性招募了过去十年来诊断为胆管炎的所有患者。记录临床和调查细节。记录胆汁和血培养结果，包括抗生素敏感性模式。评估了血液和胆汁培养物中生长的微生物的一致性及其敏感性模式。

结果

总共纳入了 1063 名胆管炎患者。他们的平均年龄为 52.7 ± 14 岁，其中 65.4% 为男性。372 名 (35%) 患者的血培养结果呈阳性。384 例患者进行了胆汁培养，阳性率为 84.4%，显着高于血培养率（p  < 0.001）。胆汁中的多种微生物生长 (59.3%) 多于血培养物中的生长 (13.5%, p  < 0.001)。大肠杆菌、克雷伯氏菌、肠球菌和假单胞菌是从血液和胆汁中分离出的四种最常见的微生物。分别在 57.7% 和 58.8% 的阳性血液和胆汁培养物中分离出产生超广谱 β-内酰胺酶的微生物。在 127 名血液和胆汁培养均为阳性的患者中，大约 90% 的患者的微生物完全或部分一致。

结论

大多数胆管炎患者的胆汁和血培养物具有相似的微生物特征。由于胆汁培养的产量明显高于血培养，因此它们可以有效指导抗菌治疗，特别是对于血培养阴性的患者。

图形概要