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
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