Value of bile aspiration during ERCP in acute cholangitis

Aims Acute cholangitis (AC) is a biliary tract infection with in-hospital mortality rates reaching up to 14.7%. The underlying condition is biliary obstruction caused by benign and malignant etiologies, as well as bacteriobilia, with commom bile duct (CBD) stone being one of the most common causes. Currently, the diagnosis is validated using Tokyo Guidelines 2018 criteria. The cornerstone of treatment for acute cholangitis is source control with biliary drainage and early antibiotics. Targeted antimicrobial therapy can favour good clinical outcomes and can avoid recurrence of infection and early stent occlusion in patients with acute cholangitis. The primary aim of this study was to describe the microbiology of bile aspirate pathogens obtained at the time of endoscopic retrograde cholangiopancreatography (ERCP) in patients suspected of having acute cholangitis.

Methods In this single-center prospective study, patients were included if a bile aspirate was collected at ERCP for suspicion of acute cholangitis, from 1 January 2023 to September 2024. We divided the patients according to their severity of cholangitis from 2018 Tokyo Guidelines (TG18) and the microorganism found in the bile culture. Finally, we compared the bile culture findings with the blood culture.

Results 56 patients were included in this study, with a mean age of 49.5±14.1 years old. The male to female ratio was 1.06 with 49 positive bile cultures (91.8%). Pathogens included: Escherichia coli (55,2%); Klebsiella spp. (24.6%); Enterococcus species (spp.) (10,5%) and anaerobes 64 (9.7%). Cultures from the biliary aspirate grew single organism in 63 patients (63 %), two organisms in 31 patients (31 %) and three organisms in 6 patients (6 %). The sterile bile culture rate decreased with the increasing severity of acute cholangitis: TG18 grade I (mild) 5/12 16,6% vs. grade II (moderate) 4/26 (15%) vs grade III (severe) 2/18 (10 %).Susceptibility of Klebsiella pneumoniae and E.coli isolates to ciprofloxacin was 88% and 64%, respectively. Extended-spectrum beta-lactamases and carbapenem resistance were found in 7.9% and 3.6% of Enterobacteriaceae, respectively. There were 39 concurrent blood cultures, of which 27 were positive

Conclusions ERCP guided bile culture is a reliable tool for targeted antimicrobial therapy with a higher sensitivity when compared to blood culture

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025