Colonisation of bile ducts with Enterococcus sp. associates with the prognosis of Primary Sclerosing Cholangitis

Background and Aims We have recently described an altered biliary microbiota composition in Primary Sclerosing Cholangitis (PSC) with a high abundance of Enterococcus sp. Little is known about the impact of these findings on the clinical course of disease.

Method We here investigated the association of bile fluid culture results obtained routinely during ERCP on major clinical endpoints in a large single center cohort of PSC patients. Peri-interventional i. v. antibiotics were given as standard after the sampling of bile fluid, and procedures with overt bacterial cholangitis and receiving antibiotic treatment prior to ERCP were excluded enabling the analysis of biliary colonization on disease course.

Results Microbiological culture results from 591 ERCP were included. Bacteria grew in 75 % of biliary cultures and in 32% of first time ERCP procedures. Positive bile cultures were significantly associated with development of cirrhosis and its complications and survival free of liver transplantation. The presence of Enterococcus faecalis and/or faecium in bile fluid conferred risk of disease progression with a HR of 2.28 (95% CI 1.32-3.9.2, p < 0.005) for achieving clinical endpoints and HR of 1.9 (95% CI 1.05-3.41, p < 0.05) for survival free of liver transplantation.

Conclusion The strong association between bile duct colonization with Enterococcus sp and disease progression highlights the importance of microbiota-mucosal interplay for the pathogenesis of PSC. These results should stimulate further mechanistic studies on the role of microbiota for biliary inflammation in PSC.

Publication History

Article published online:
26 January 2022