Routine bile collection for microbiological analysis during cholangiography and its impact on the management of cholangitis

• Published in: Gastrointestinal endoscopy 2010-08, Vol.72 (2), p.284-291
• Main Authors: Negm, Ahmed A., MD, Schott, Anja, MD, Vonberg, Ralf-Peter, MD, Weismueller, Tobias J., MD, Schneider, Andrea S., MD, Kubicka, Stefan, MD, Strassburg, Christian P., MD, Manns, Michael P., MD, Suerbaum, Sebastian, MD, Wedemeyer, Jochen, MD, Lankisch, Tim O., MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Bacteria - isolation & purification; Bile - microbiology; Cholangiography - methods; Cholangitis - diagnosis; Cholangitis - drug therapy; Cholangitis - microbiology; Colony Count, Microbial; Diagnosis, Differential; Female; Follow-Up Studies; Gastroenterology and Hepatology; Humans; Male; Middle Aged; Prognosis; Prospective Studies; Young Adult
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2010.02.043

Background Antibiotic treatment of cholangitis is often insufficient because of inappropriate antibiotic use or bacterial resistance. Objective To evaluate the role of routine bile collection during endoscopic retrograde cholangiography or percutaneous transhepatic cholangiography for microbiological analysis in the antibiotic management of cholangitis and to identify risk factors of bacteriobilia. Design Prospective, observational, diagnostic study. Setting Hannover Medical School, Hannover, Germany. Patients and Intervention This study involved 243 consecutive patients undergoing endoscopic retrograde cholangiography/percutaneous transhepatic cholangiography for biliary complications after orthotopic liver transplantation (27%), malignancy (27%), primary sclerosing cholangitis (15%), benign strictures (11%), and choledocholithiasis (8%). Main Outcome Measurements Microbiological examination of bile samples. Results Patients with biliary stents or who were receiving repeated interventions after orthotopic liver transplantation were at increased risk of bacteriobilia ( P < .05). The rate of gram-positive monomicrobial infection was higher in patients with primary sclerosing cholangitis ( P < .01). In 40 examinations, patients presented with preprocedural cholangitis although they were receiving antibiotics. According to bile culture results, the antibiotic treatment was modified to a more specific therapy in 72.5% of patients. In patients who developed cholangitis after endoscopic retrograde cholangiography (27 examinations), specific antibiotic treatment was started or refined in 67% of cases, based on bile culture results. Limitations Contamination of samples during intervention cannot be totally excluded. Conclusion Orthotopic liver transplantation, biliary stenting, and repeated interventions are risk factors of bacteriobilia. In our patients with primary sclerosing cholangitis, gram-positive monomicrobial infections were more common. A bile sample collected during cholangiography for microbiological analysis is a simple, potentially valuable, diagnostic tool in patients with cholangitis. Each center should recognize its own patterns of infection to ensure ideal targeted therapy.