Bile Culture May Guide Antibiotic Stewardship in Acute Bacterial Cholangitis.

Autor: George JT; Department of Gastroenterology, Christian Medical College, Vellore, 632002, India. johntgeorg@gmail.com., Thomas A; Department of Gastroenterology, Christian Medical College, Vellore, 632002, India., Jaleel R; Department of Gastroenterology, Christian Medical College, Vellore, 632002, India., Paul GJS; Department of Community Medicine, Christian Medical College, Vellore, 632004, India., John A; Department of Gastroenterology, Christian Medical College, Vellore, 632002, India., Kurien RT; Department of Gastroenterology, Christian Medical College, Vellore, 632002, India., Chowdhury SD; Department of Gastroenterology, Christian Medical College, Vellore, 632002, India., Simon EG; Department of Gastroenterology, Christian Medical College, Vellore, 632002, India., Joseph AJ; Department of Gastroenterology, Christian Medical College, Vellore, 632002, India., Dutta AK; Department of Gastroenterology, Christian Medical College, Vellore, 632002, India.
Jazyk: angličtina
Zdroj: Digestive diseases and sciences [Dig Dis Sci] 2024 May; Vol. 69 (5), pp. 1872-1879. Date of Electronic Publication: 2024 Mar 08.
DOI: 10.1007/s10620-024-08289-w
Abstrakt: Background: Bile cultures are often sent with blood cultures in patients with acute bacterial cholangitis.
Aims: To assess the yield of blood and bile cultures in patients with cholangitis and the clinical utility of bile cultures in guiding therapy.
Methods: All patients diagnosed with cholangitis, based on the Tokyo 2013/2018 guidelines were recruited retrospectively over ten years. The clinical and investigation details were recorded. The results of bile and blood cultures including antibiotic sensitivity patterns were noted. The concordance of microorganisms grown in blood and bile cultures and their sensitivity pattern were assessed.
Results: A total of 1063 patients with cholangitis were included. Their mean age was 52.7 ± 14 years and 65.4% were males. Blood cultures were positive in 372 (35%) patients. Bile culture was performed in 384 patients with 84.4% being positive, which was significantly higher than the yield of blood culture (p < 0.001). Polymicrobial growth was more in bile (59.3%) than in blood cultures (13.5%, p < 0.001). E.coli, Klebsiella, Enterococcus and Pseudomonas were the four most common organisms isolated from both blood and bile. Extended spectrum betalactamase producing organisms were isolated in 57.7% and 58.8% of positive blood and bile cultures, respectively. Among 127 patients with both blood and bile cultures positive, complete or partial concordance of organisms was noted in about 90%.
Conclusion: Bile and blood cultures have a similar microbial profile in most patients with cholangitis. As bile cultures have a significantly higher yield than blood cultures, they could effectively guide antimicrobial therapy, especially in those with negative blood cultures.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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