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CC BY-NC-ND 4.0 · Journal of Gastrointestinal Infections
DOI: 10.1055/s-0045-1811578
Original Article

Microbial Profile and Antibiotic Susceptibility of Organisms in Bile Cultures from Patients Undergoing Endoscopic Retrograde Cholangiography: A Cross-Sectional Study from a Tertiary-Care Center in Nepal

Autoren

  • Swarup Shrestha 

    1   Department of Gastroenterology, National Academy of Medical Sciences, Bir Hospital, Mahaboudha, Kathmandu, Nepal

  • Bhupendra K. Basnet

    1   Department of Gastroenterology, National Academy of Medical Sciences, Bir Hospital, Mahaboudha, Kathmandu, Nepal

  • Ajit Khanal

    1   Department of Gastroenterology, National Academy of Medical Sciences, Bir Hospital, Mahaboudha, Kathmandu, Nepal

  • Nandu S. Poudyal

    1   Department of Gastroenterology, National Academy of Medical Sciences, Bir Hospital, Mahaboudha, Kathmandu, Nepal

  • Mukesh S. Poudel 

    1   Department of Gastroenterology, National Academy of Medical Sciences, Bir Hospital, Mahaboudha, Kathmandu, Nepal

Funding None.
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Abstract

Background

Acute cholangitis, a potentially life-threatening biliary infection, frequently arises from biliary obstruction. Prompt diagnosis and appropriate antimicrobial therapy are critical to preventing sepsis and reducing mortality. Empirical antibiotic selection requires an understanding of local microbial profiles and resistance patterns.

Objectives

This study aims to describe the microbial profile and antibiotic resistance patterns in bile cultures obtained from patients undergoing endoscopic retrograde cholangiography (ERC) at a tertiary-care teaching hospital in Kathmandu, Nepal, and assess if there is a difference in prevalence rates between these groups.

Methods

This cross-sectional study was conducted at a tertiary-care teaching hospital in Nepal between November 2023 and April 2024. A total of 88 patients (44 with acute cholangitis and 44 without) undergoing ERC were included. Bile samples were aseptically collected, cultured, and analyzed for microbial identification and antibiotic susceptibility. Statistical analysis was performed with a two-tailed two-sample proportion z-test to compare bile culture positivity and microbial patterns between groups.

Results

Of the 88 patients, 74 (84%) had positive bile cultures, with a significantly higher prevalence in the cholangitis group (93%) compared with those without cholangitis (75%, p = 0.041). Gram-negative organisms predominated, with Escherichia coli (38%), Citrobacter (30%), and Klebsiella (19%) being the most common. Pseudomonas species were isolated exclusively in the cholangitis group. Antibiotic resistance rates were high, including multidrug resistance among Pseudomonas and Enterobacter isolates.

Conclusion

This study highlights the high prevalence of gram-negative pathogens in ERC patients with cholangitis, emphasizing targeted empiric therapy and antimicrobial stewardship.

Keywords

acute cholangitis - endoscopic retrograde cholangiography - antibiotic resistance - Nepal

Ethical Statement

Ethical clearance was obtained from the Institutional Review Board of NAMS (reference number: 1041/2080/81).


Informed Consent

All participants provided written informed consent before their inclusion in the study, with assurances of confidentiality.


Authors' Contributions

S.S. conceptualized and designed the study, collected data, performed data analysis and interpretation, and drafted the initial manuscript. B.K.B. supervised the study, contributed to study design and methodology, guided data interpretation, and revised the manuscript for important intellectual content. A.K. and N.S.P. provided critical input and revised the manuscript for important intellectual content. M.S.P. contributed to study design and methodology, guided data interpretation, and revised the manuscript for important intellectual content. All authors read and approved the final version of the manuscript. B.K.B. served as the guarantor of the work.


Data Availability Statement

The data can be obtained from the corresponding author upon a reasonable request.


Supplementary Material



Publikationsverlauf

Eingereicht: 26. April 2025

Angenommen: 30. Juli 2025

Artikel online veröffentlicht:
09. Oktober 2025

© 2025. Gastroinstestinal Infection Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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