Original ArticlesMicrobiology of bile in patients with cholangitis or cholestasis with and without plastic biliary endoprosthesis☆
Section snippets
Patients and methods
Our ERCP database was queried for patients referred for evaluation of cholestasis with or without cholangitis. From January 1994 to January 2000, 160 patients (89 men, 71 women; mean age 55 years, range 6-94 years) underwent 180 procedures in which bile was collected and submitted for microbial analysis. Sixty-nine ERCPs were performed in patients who did not have a biliary stent (group 1) and 111 in patients with at least 1 biliary stent in situ (group 2). The primary diagnoses for patients in
Results
One hundred eighty cultures were obtained from 160 patients. Cultures were positive for 147 of 180 (82%) bile specimens. Patients with a stent in place were significantly more likely to have bacterobilia (Table 1): group 1 (no stent), 38/69 (55%), versus group 2 (with stent), 109/111 (98%)(p < 0.05).
Empty Cell n Positive bile culture Negative bile culture Group 1* 69 38 (55%)‡ 31 (45%) Group 2† 111 109 (98%)§ 2 (2%) Total 180 147 (82%) 33 (18%) *
Discussion
Before the widespread use of therapeutic ERCP, bile culture data were typically obtained from patients with cholestasis who underwent surgical decompression of the biliary system. Delikaris et al.4 found the frequency of bacterobilia to be 26% among specimens obtained intraoperatively. Among 90 patients undergoing biliary tract surgery, Mason5 found that 43 cultures (48%) exhibited bacterial growth, 22 of which were polymicrobial. Bacterial migration has been suggested as an important factor in
References (21)
- et al.
Prophylactic antibiotic treatment in therapeutic or complicated diagnostic ERCP: results of a randomized controlled clinical study
Gastrointest Endosc
(1994) - et al.
Biliary stent associated infection
J Hosp Infect
(1991) - et al.
Is there a synergistic effect between mixed bacterial infection in biofilm formation on biliary stents?
Gastrointest Endosc
(1998) - et al.
Antibiotics, biliary sepsis, and bile duct stones
Gastrointest Endosc
(1994) - et al.
Biliary tract infections: a guide to drug treatment
Drugs
(1999) - et al.
Antibiotic prophylaxis for infectious complications after therapeutic endoscopic retrograde cholangiopancreatography: a randomized double-blind, placebo-controlled study
Clin Infect Dis
(1995) - et al.
Biliary bacteriology based on intraoperative bile culture
Am J Gastroenterol
(1977) Bacteriology and antibiotic selection in biliary tract surgery
Arch Surg
(1968)- et al.
Clogging of biliary endoprosthesis. A morphologic and bacteriologic study
Scand J Gastroenterol
(1991) Performance standards for antimicrobial disk susceptibility testing approved standard M2-A4
(1997)
Cited by (133)
EASL Clinical Practice Guidelines on sclerosing cholangitis
2022, Journal of HepatologyClinical characteristics, aetiology and mortality/recurrence risk factors of acute cholangitis in patients with and without biliary stent
2021, Enfermedades Infecciosas y Microbiologia ClinicaProton Pump Inhibitors Increase the Risk of Early Biliary Infection After Placement of Percutaneous Transhepatic Biliary Stents
2021, Journal of Vascular and Interventional RadiologyCitation Excerpt :The study concluded that PPIs seemed to enrich the number and broaden the spectrum of biliary microorganisms. Meanwhile, 2 studies also showed identical results, revealing that the most prominent biliary microorganisms were Enterobacteriaceae (22, 29). Recently, Yang et al (13) reported that the overall incidence of cholangitis was 6.1-fold higher among patients treated with PPIs, and Chuang et al (30) reported that the incidence of cholecystitis was 1.2-fold greater in patients treated with PPIs than in patients without PPIs.
Microbiology of bile in extrahepatic biliary obstruction: A tropical experience
2021, Indian Journal of Medical MicrobiologyCitation Excerpt :Similar results have been documented by other studies over the past two decades [13] and lately Basioukas et al. showed E. coli in about 50% growth which is similar to our results [14]. A loss of the barrier between the biliary tract and the duodenal lumen, due to the stent placement, is an important factor in ascending bacterial ductal colonisation [15], polymicrobial cultures [14] and biliary stent associated cholangitis [16]. We demonstrated that stenting had a significant impact on the positivity of culture [with 84.4% of stented patients having a growth as compared to 57.5% of unstented patients: Fig. 2] and polymicrobial growth [35.2% in stented vs. 15.8% in unstented: Fig. 3].
- ☆
Reprint requests: Evan Fogel, MD, 550 N. University Blvd., Suite 4100, Indianapolis, IN 46202.