Microbiological profile and antimicrobial sensitivity pattern in acute bacterial cholangitis

Introduction - Initial therapy of acute cholecystitis and cholangitis is directed towards general support of the patient, including fluid and electrolyte replacement, correction of metabolic imbalances and antibacterial therapy. Antimicrobial therapy is usually empirical. Initial therapy should cover the Enterobacteriaceae, in particular Escherichia coli. Activity against enterococci is not required since their pathogenicity in biliary tract infections remains unclear. The changing antimicrobial sensitivity pattern of causative organisms poses a therapeutic challenge in treating patients with acute cholangitis. We therefore evaluated the microbial profile and sensitivity pattern to antibiotics in patients with acute bacterial cholangitis. Methods - Data of patients above 18 years of age with acute bacterial cholangitis seen between January 2011 and December 2011 were retrospectively analyzed. Data on clinical features, etiological and microbial profile and therapy, and patient outcomes were analyzed Results - Twenty five patients with acute cholangitis were studied. Choledocholithiasis (72.7) and malignancy (19.2) were the main predisposing factors. Bile culture was positive in 23 of 25 patients, and blood culture was positive in 7 patients. Bile cultures were predominantly polymicrobial (45) in contrast to blood cultures (2.2). E. coli was the predominant isolate in blood and bile. No growth was seen on anaerobic bile or blood cultures. There was a resistance of E. coli to third generation cephalosporins.Conclusions - Changing antimicrobial sensitivity patterns requires a revision of empiric antibiotic therapy policy in cholangitis.