A Clinico-Microbiological Profile of Patients with Acute Cholangitis

The aim for the present study was to determine the clinico-microbiological profile and antimicrobial susceptibility patterns of organisms isolated from bile aspirates during endoscopic retrograde cholangiopancreatography (ERCP) in patients with acute cholangitis. In this prospective, observational, single-center study, bile aspirates and blood from consecutive patients undergoing ERCP for acute cholangitis were collected for culture. Demographic, outcome, and microbiological data were collected. Multivariate logistic regression was used to identify factors associated with adverse outcomes. Bile aspirates from 117 patients were collected; 95 (81.2%) yielded positive culture results, and 101 isolates were identified. Gram-negative organisms were the most frequently isolated, with Escherichia coli (E. coli; 50.5%), Pseudomonas spp. (21.8%), and Klebsiella spp. (15.8%), being the most common. Extended-spectrum beta-lactamase production and carbapenem resistance were observed in 79.1% and 29.2% of Gram-negative isolates, respectively. Among 64/117 (54.7%) concurrent blood cultures, 11 (17.2%) were positive. A biliary endoscopic sphincterotomy had been conducted previously in 43 cases (36.8%) and was associated with a higher frequency of E. coli and carbapenem-resistant Klebsiella pneumoniae (CRKP). Multivariate analysis revealed that male sex (odds ratio OR: 4.2; P = 0.05) and malignant biliary obstruction (OR: 8.1; P = 0.005) were independently associated with worse outcomes. Bile cultures frequently yield multidrug-resistant organisms in acute cholangitis. A previous biliary sphincterotomy increases the risk of drug-resistant infections, particularly CRKP. These findings highlight the importance of local microbiological surveillance and individualized empirical therapy.