Aims Targeted antimicrobial therapy can favour good clinical outcomes and can avoid recurrence of infection and early stent occlusion in patients with acute cholangitis. This study compares the microbial yield of blood cultures and bile aspirate cultures in patients with ascending cholangitis.
Methods We reviewed the medical records of patients suspected of acute cholangitis in our Endoscopy Department between June 2018 and December 2020. All patients underwent ERCP and bile culture was aspirated during the procedure. 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 128 patients were included in this study, with a mean age of 69.5 ± 14.1 years old. The male to female ratio was 1.06. Bile culture was sterile in 28/128 (21.9 %). E. Coli was involved in 54/100 (54 %), Klebsiella in 31/100 (31 %) and Enterococcus in 16/100(16 %) of the cases. 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) 7/30 (23.3 %) vs. grade II (moderate) 15/67 (22.4 %) vs grade III (severe) 6/31 (19.4 %). Two organisms or more were found in 56 % of severe (grade III) acute cholangitis compared to mild and moderate cases, 30.4 % and 29.2 %, respectively. 24 patients had positive blood and bile culture. 17/24 (70.8 %) had involved the same organism and 7/24 (29.2 %) had different microorganisms involved. More than half of the sterile blood cultures (60.3 %) are positive in bile culture.
Conclusions ERCP guided bile culture is a reliable tool for targeted antimicrobial therapy with a higher sensitivity when compared to blood culture.
Citation: Burciu C, Sporea I, Ratiu I et al. OP115 USEFULNESS OF ERCP BILE ASPIRATED CULTURE IN PATIENTS WITH ACUTE CHOLANGITIS. Endoscopy 2021; 53: S48.
