Bacteriological Spectrum in Bile and Outcomes in Patients of Acute Bacterial Cholangitis

With indiscriminate use of antibiotics, newer strains of resistant organisms are emerging. We analysed the clinical and microbial profile of patients with acute bacterial cholangitis who underwent endoscopic retrograde cholangiopancreatography (ERCP). It was a case series analysis. Consecutive patients with cholangitis were included. Bile obtained during biliary cannulation, was cultured and microbial isolates and their antibiotic susceptibility was documented. Demographic, clinical, laboratory parameters were recorded. 116 patients were included. Most common symptoms were abdominal pain (89.6%), jaundice (84.4%) and fever (56.8%). 81.9% had positive bile culture and 17.9% of positive bile cultures showed polymicrobial growth. 92.9% of the organisms were gram negative bacteria (GNB) with Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae constituting 85% of the isolates. Enterococcus spp. (7%) constituted all gram—positive organisms. GNB had highest sensitivity to aminoglycosides (69.6–78.4%) and tigecycline (80–88.4%) and had lowest sensitivity to cephalosporins (21.5–33.3%), fluoroquinolones (18.1–26.7%). In-hospital mortality was 10.3%. Low serum albumin levels and septic shock were associated with mortality on multivariate analysis. Gram negative bacilli are the most common bacterial isolates in the bile culture and emergence of carbapenem resistant organisms poses a major therapeutic challenge.