{
  "abstract": "Introduction Acute cholangitis management relies on broad-spectrum antibiotics and biliary drainage. While bile cultures often yield polymicrobial flora, their role in guiding therapy remains debated. This study aimed to describe the bacteriological profile of bile cultures in acute cholangitis and to assess their influence on antibiotic management.Methods A retrospective 2-year from January 2024 to December 2025 study included consecutive patients with acute cholangitis (Tokyo criteria). All underwent ERCP-guided biliary drainage with bile sampling for culture and susceptibility testing. Severity and microbiological-based antibiotic modifications were analyzed.Results A total of 121 patients were included (mean age 63.1 years, range 19–92), with a slight female predominance (52%). The main etiologies were malignant biliary obstruction (35.7%), mainly pancreatic head tumours, cholangiocarcinoma and gallbladder cancer, and common bile duct lithiasis (27.8%). According to Tokyo classification, 44.1% of patients had grade I, 42.4% grade II and 13.5% grade III cholangitis.Bile cultures were analysed in 121 patients and were positive in 97 cases (80.2%), while 24 samples remained sterile. Polymicrobial growth was observed in 39 patients. A total of 129 isolates were recovered, with a clear predominance of Gram-negative bacilli. Pseudomonas aeruginosa (23.3%), Escherichia coli (22.5%) and Klebsiella pneumoniae (12.4%) were the most frequently isolated pathogens. Other Gram-negative organisms included Enterobacter cloacae (5.4%), Citrobacter freundii and Proteus mirabilis (4.7% each). Gram-positive cocci were mainly represented by enterococci (Enterococcus faecalis 3.1%, Enterococcus faecium 2.3%), followed by Streptococcus spp. (2.3%) and Staphylococcus aureus (1.6%). Anaerobic bacteria were identified in 3.9% of positive cultures, and Candida species accounted for 10.2% of isolates.Overall susceptibility analysis showed that amikacin was the most active antibiotic (93.3%), followed by imipenem (77.9%) and piperacillin–tazobactam (77.2%). Ceftriaxone demonstrated intermediate activity (66.7%), whereas amoxicillin–clavulanate showed low overall sensitivity (31.4%), particularly in grade II disease.Antibiotic therapy was modified in 46 patients (38.0%). Escalation due to resistance identified on antibiogram was required in 12 cases (26.1% of modifications), mainly in patients with grade II cholangitis. Conversely, de-escalation and switch to oral therapy were achieved in 34 patients (73.9%) following confirmation of susceptibility and satisfactory clinical response after biliary drainage.Conclusion Bile cultures in acute cholangitis show high yield, dominated by Gram-negative organisms with heterogeneous resistance. With modifications required in over one-third of patients—predominantly enabling de-escalation—routine bile sampling is essential for optimizing antibiotic stewardship.",
  "authors": [
    {
      "affiliations": [
        "Hepatogastroenterology Medicine C, Ibn Sina hospital, Mohamed V University, Rabat, Morocco"
      ],
      "name": "Ismail Qarch"
    },
    {
      "affiliations": [
        "Hepatogastroenterology Medicine C, Ibn Sina hospital, Mohamed V University, Rabat, Morocco"
      ],
      "name": "Maryeme Kadiri"
    },
    {
      "affiliations": [
        "Hepatogastroenterology Medicine C, Ibn Sina hospital, Mohamed V University, Rabat, Morocco"
      ],
      "name": "Nawal Lagdali"
    },
    {
      "affiliations": [
        "Hepatogastroenterology Medicine C, Ibn Sina hospital, Mohamed V University, Rabat, Morocco"
      ],
      "name": "Fatima Zohra Ajana"
    },
    {
      "affiliations": [
        "Hepatogastroenterology Medicine C, Ibn Sina hospital, Mohamed V University, Rabat, Morocco"
      ],
      "name": "Mohamed Borahma"
    }
  ],
  "title": "P13 Impact of bile cultures on antibiotic management in acute cholangitis",
  "uid": "d206a8b4-a149-5b36-afc9-e40a2820af08"
}