Endoscopic Retrograde Cholangio-Pancreatography-Obtained Bile Culture Can Guide Antibiotic Therapy in Acute Cholangitis

Chandra, Subhash; Klair, Jagpal S.; Soota, Kaartik; Livorsi, Daniel J; Johlin, Frederick C.

doi:10.1159/000493579

Cited by 28 publications

(16 citation statements)

References 14 publications

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“…The most common microorganisms in blood were still Escherichia coli, Klebsiella pneumoniae , and Enterococcus faecalis. The results are consistent with the findings of bile culture in the present study and are confirmed by several studies [ 4 , 28 , 36 ]. Blood culture seems to be a much more convenient way to detect pathogenic microorganisms without complicated procedures.…”

Section: Discussionsupporting

confidence: 94%

“…Blood culture seems to be a much more convenient way to detect pathogenic microorganisms without complicated procedures. However, previous studies revealed that more than half of the BTIs patients were negative for blood culture [ 4 , 36 ], indicating that bacteria abundance in blood culture might be depressed. The results of our study also confirmed that the abundance of bacteria in bile culture is greater than blood culture.…”

Section: Discussionmentioning

confidence: 99%

“…The fact that Staphylococcus epidermidis in blood culture is significantly higher than bile culture ( P =0.027) also indicates that there might be a discrepancy between bile culture and blood culture. Besides, Rossolini and other researchers also proved that drug-resistant microorganisms such as Pseudomonas were much easier to detect from bile samples than blood [ 36 , 37 ]. Therefore, blood culture alone as the reference of optimal empirical antibiotic therapy is inadequate and might result in growing mortality and healthcare costs for patients with BTIs.…”

Section: Discussionmentioning

confidence: 99%

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A Retrospective Study on Bile Culture and Antibiotic Susceptibility Patterns of Patients with Biliary Tract Infections

Zhao

Liu

Bai

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Aim. This study aimed to provide profiles of microorganisms isolated from bile and antibiotic susceptibility patterns of biliary tract infections (BTIs) in our center. Methods. A total of 277 patients diagnosed with BTIs at the Second Affiliated Hospital of Harbin Medical University from 2011 to 2018 were included in this study. Medical records were reviewed to obtain clinical and demographic data. Bile specimens were prepared through endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiodrainage (PTCD), and percutaneous transhepatic gallbladder drainage (PTGD) under aseptic conditions. In those with positive bile culture results, blood cultures were concurrently conducted. The concordance of the results between bile culture and blood culture were also analysed. Results. Two hundred and sixty-seven bile cultures were positive, while 280 strains of micro-organisms were isolated. Among these, 76.8% were Gram-negative, 22.5% were Gram-positive and 0.7% were fungi. The most common microorganisms were Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis. Gram-negative bacteria we tested were highly sensitive to ertapenem, imipenem, tigecycline, and amikacin. Gram-positive bacteria we tested were highly sensitive to tigecycline, teicoplanin, linezolid, vancomycin, and chloramphenicol. For the 44 patients with positive bile cultures, a blood culture was also performed. Among them, 29 cases yielded positive blood culture results. Among those cases with positive blood culture, 48.3% showed complete agreement with bile culture, 3.4% showed partial agreement, and 48.3% showed disagreement. The most common microorganisms in blood culture were the same as in bile culture. Additionally, the proportion of Staphylococcus epidermidis was significantly higher in blood culture ( P < 0.05 ). Conclusion. Our study provided a comprehensive analysis of the bacteria distribution and drug resistance profiles in patients with BTIs in northern China. Further studies should be conducted to validate our findings.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A Retrospective Study on Bile Culture and Antibiotic Susceptibility Patterns of Patients with Biliary Tract Infections

Zhao

Liu

Bai

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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“…Another modality used in isolating pathogens is ERCP-obtained bile cultures. The ERCP-obtained bile cultures technique provides a significantly higher yield versus blood cultures [ 6 ]. One paper reports that the bile cultures can be positive in 59% to 93% of the acute cholangitis cases [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Ascending Cholangitis Caused by Methicillin-Resistant Staphylococcus aureus Species in a Patient With Cystic Fibrosis

Obeidat¹,

Singh²,

Altarawneh³

et al. 2021

Cureus

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Ascending cholangitis is a bacterial infection of the extra-hepatic biliary system and presents as a life-threatening systemic condition. Increased bacterial loads and biliary obstruction favor bacterial translocation into the vascular and lymphatic systems. Common organisms isolated are Escherichia Coli , Klebsiella , Enterococcus species, and Enterobacter species . Methicillin-resistant Staphylococcus aureus (MRSA) is a rare isolate in ascending cholangitis. We present a case of a 24-year-old patient with cystic fibrosis who presented with epigastric abdominal pain, low-grade fever, jaundice, dark urine, and nausea for two days. Initial workup revealed elevated liver enzymes, hyperbilirubinemia, leukocytosis, and an ultrasound which showed common bile duct dilation to 14 mm with choledocholithiasis. He underwent endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction and bile fluid culture. Cultures grew out MRSA and the patient was treated with appropriate antibiotic therapy. The mainstay of therapy for ascending cholangitis is adequate hydration, antibiotics, and biliary decompression. Early recognition of the offending organism is critical in guiding therapy. Current guidelines focus on the empiric treatment of Gram-negative and anaerobic bacteria. Clinicians should be aware of the possibility of less common pathogens (such as MRSA), especially in a patient who is decompensating despite antibiotic therapy.

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“…Cultures of bile obtained during ERCP in patients with cholangitis are much more often positive for microorganisms than blood cultures (97 % vs. 32 % in a retrospective study of 93 patients) [250]. In a study where bile culture was performed routinely, it allowed initiation of the appropriate antibiotic or refinement of a specific antibiotic treatment for 67 % of 27 ERCPs which were complicated by cholangitis [251].…”

Section: Post-ercp Cholangitismentioning

confidence: 99%

ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2019

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Main Recommendations Prophylaxis 1 ESGE recommends routine rectal administration of 100 mg of diclofenac or indomethacin immediately before endoscopic retrograde cholangiopancreatography (ERCP) in all patients without contraindications to nonsteroidal anti-inflammatory drug administration.Strong recommendation, moderate quality evidence. 2 ESGE recommends prophylactic pancreatic stenting in selected patients at high risk for post-ERCP pancreatitis (inadvertent guidewire insertion/opacification of the pancreatic duct, double-guidewire cannulation).Strong recommendation, moderate quality evidence. 3 ESGE suggests against routine endoscopic biliary sphincterotomy before the insertion of a single plastic stent or an uncovered/partially covered self-expandable metal stent for relief of biliary obstruction.Weak recommendation, moderate quality evidence. 4 ESGE recommends against the routine use of antibiotic prophylaxis before ERCP.Strong recommendation, moderate quality evidence. 5 ESGE suggests antibiotic prophylaxis before ERCP in the case of anticipated incomplete biliary drainage, for severely immunocompromised patients, and when performing cholangioscopy.Weak recommendation, moderate quality evidence. 6 ESGE suggests tests of coagulation are not routinely required prior to ERCP for patients who are not on anticoagulants and not jaundiced.Weak recommendation, low quality evidence. Treatment 7 ESGE suggests against salvage pancreatic stenting in patients with post-ERCP pancreatitis.Weak recommendation, low quality evidence. 8 ESGE suggests temporary placement of a biliary fully covered self-expandable metal stent for post-sphincterotomy bleeding refractory to standard hemostatic modalities.Weak recommendation, low quality evidence. 9 ESGE suggests to evaluate patients with post-ERCP cholangitis by abdominal ultrasonography or computed tomography (CT) scan and, in the absence of improvement with conservative therapy, to consider repeat ERCP. A bile sample should be collected for microbiological examination during repeat ERCP.Weak recommendation, low quality evidence.

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Endoscopic Retrograde Cholangio-Pancreatography-Obtained Bile Culture Can Guide Antibiotic Therapy in Acute Cholangitis

Cited by 28 publications

References 14 publications

A Retrospective Study on Bile Culture and Antibiotic Susceptibility Patterns of Patients with Biliary Tract Infections

A Retrospective Study on Bile Culture and Antibiotic Susceptibility Patterns of Patients with Biliary Tract Infections

Ascending Cholangitis Caused by Methicillin-Resistant Staphylococcus aureus Species in a Patient With Cystic Fibrosis

ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

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