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Bile Culture May Guide Antibiotic Stewardship in Acute Bacterial Cholangitis

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Abstract

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.

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Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Gastroenterology, Christian Medical College, Vellore, 632002, India

    John Titus George, Ajith Thomas, Rajeeb Jaleel, Anoop John, Reuben Thomas Kurien, Sudipta Dhar Chowdhury, Ebby George Simon, A. J. Joseph & Amit Kumar Dutta

  2. Department of Community Medicine, Christian Medical College, Vellore, 632004, India

    G. Jackwin Sam Paul

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  1. John Titus George
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  2. Ajith Thomas
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Contributions

JTG, AKD and RJ were involved in planning the study. JTG, AT, AJ and RJ were involved in data extraction. Statistical analysis was done by JTG and JSPG. JTG, JSPG, RJ, AJ, AKD AT, RTK, SDC, EGS and AJJ were involved in drafting the manuscript. Critical revision of the manuscript was performed by AKD, EGS, RTK, RJ, SDC and AJJ.

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Correspondence to John Titus George.

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George, J.T., Thomas, A., Jaleel, R. et al. Bile Culture May Guide Antibiotic Stewardship in Acute Bacterial Cholangitis. Dig Dis Sci (2024). https://doi.org/10.1007/s10620-024-08289-w

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