Cholangitis is a frequent complication of biliary stents. Empiric antibiotic selection is based primarily on the results of bile cultures obtained from surgical patients and limited data from the ERCP era. This study was undertaken to analyze the microbiology of bile and the sensitivities of the organisms identified in stented patients presenting with clinical cholangitis or cholestasis. METHODS: We reviewed all bile cultures collected during ERCP from 11/93 to 8/95. Specimens were collected with a sterile catheter prior to the injection of contrast. Duodenoscopes were washed for 20 minutes in 2% glutaraldehyde just prior to use. RESULTS: Seventy-three cultures from 57 patients ranging in age from 12-85 (mean 60) were identified. Thirty-eight patients (50 cultures) had indwelling plastic biliary stents at the time of culture (Grp 1) and 23 patients (23 cultures) had no previous history of biliary stents (Grp 2) . Four patients initially included in Grp 2 subsequently had a repeat bile culture while a biliary stent was in place. The primary diagnosis for patients in Grps 1, 2 were: malignant bile duct obstruction (n=30, 10), choledocholithiasis (n=0, 8), benign stricture from chronic pancreatitis (n=4, 2), anastomotic stricture after liver transplantation (n=4, 3). Grp 1 (n=50) Grp 2 (n=23) Positive Cultures 48(96%) (p<0.001) 14 (61%) Prior antibiotics 42 (84%) (p=0.07) 15(65%) Enterococcus (EC) 34 (68%) (p<0.001) 2 (9%) Enterobacteriaceae Sp. (EB) 25 (50%) (p=0.02) 5 (22%) Candida (CN) 22 (44%) (p=0.027) 4 (17%) Pseudomonas 4 (8%) (4%) Polymicrobial 38 (76%) (p<0.001) 6 (26%) Antibiotic sensitivities for stented patients with EC were: vancomycin (VC)100%, norfloxacin (NF) 50% and ampicillin 8%. The gram negative rod (GNR) organisms in the stented group had the following antibiotic sensitivities: imipenem (IP) 100%, ciprofloxacin (CF) 100%, and cefoperazone (CP) 88%. SUMMARY: EC, EB, or CN were present in 95% of bile cultures in patients with cholangitis/cholestasis and biliary stents. Stented patients had a significantly higher prevalence of EC, CN and EB compared to those patients without stents. VC and either IP, CF, or CP would provide the roadest antibiotic coverage for patients with biliary stents, CONCLUSION: Since Quinolones (CF,NF) effectively penetrate into the obstructed biliary tree and can be administered orally, they can provide excellent GNR and good EC coverage for stented patients prior to stent exchange. The role of CN as a putative organism for cholangitis or stent occlusion unknown.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging