{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T16:17:50Z","timestamp":1778084270949,"version":"3.51.4"},"reference-count":52,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,6]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    The aim for the present study was to determine the clinico-microbiological profile and antimicrobial susceptibility patterns of organisms isolated from bile aspirates during endoscopic retrograde cholangiopancreatography (ERCP) in patients with acute cholangitis. In this prospective, observational, single-center study, bile aspirates and blood from consecutive patients undergoing ERCP for acute cholangitis were collected for culture. Demographic, outcome, and microbiological data were collected. Multivariate logistic regression was used to identify factors associated with adverse outcomes. Bile aspirates from 117 patients were collected; 95 (81.2%) yielded positive culture results, and 101 isolates were identified. Gram-negative organisms were the most frequently isolated, with\n                    <jats:italic>Escherichia coli<\/jats:italic>\n                    (\n                    <jats:italic>E. coli<\/jats:italic>\n                    ; 50.5%),\n                    <jats:italic>Pseudomonas<\/jats:italic>\n                    spp. (21.8%), and\n                    <jats:italic>Klebsiella<\/jats:italic>\n                    spp. (15.8%), being the most common. Extended-spectrum beta-lactamase production and carbapenem resistance were observed in 79.1% and 29.2% of Gram-negative isolates, respectively. Among 64\/117 (54.7%) concurrent blood cultures, 11 (17.2%) were positive. A biliary endoscopic sphincterotomy had been conducted previously in 43 cases (36.8%) and was associated with a higher frequency of\n                    <jats:italic>E. coli<\/jats:italic>\n                    and carbapenem-resistant\n                    <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                    (CRKP). Multivariate analysis revealed that male sex (odds ratio [OR]: 4.2;\n                    <jats:italic>P<\/jats:italic>\n                    = 0.05) and malignant biliary obstruction (OR: 8.1;\n                    <jats:italic>P<\/jats:italic>\n                    = 0.005) were independently associated with worse outcomes. Bile cultures frequently yield multidrug-resistant organisms in acute cholangitis. A previous biliary sphincterotomy increases the risk of drug-resistant infections, particularly CRKP. These findings highlight the importance of local microbiological surveillance and individualized empirical therapy.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0488","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T14:52:47Z","timestamp":1773154367000},"page":"832-836","source":"Crossref","is-referenced-by-count":0,"title":["A Clinico-Microbiological Profile of Patients with Acute Cholangitis"],"prefix":"10.4269","volume":"114","author":[{"given":"Souradeep","family":"Chowdhury","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine and Microbiology, AIIMS, New Delhi, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sagnik","family":"Biswas","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, AIIMS, New Delhi, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soumya J.","family":"Mahapatra","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, AIIMS, New Delhi, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepak","family":"Gunjan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, AIIMS, New Delhi, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ankur","family":"Goyal","sequence":"additional","affiliation":[{"name":"Department of Radiology, AIIMS, New Delhi, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hitender","family":"Gautam","sequence":"additional","affiliation":[{"name":"Department of Microbiology, AIIMS, New Delhi, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bimal Kumar","family":"Das","sequence":"additional","affiliation":[{"name":"Department of Microbiology, AIIMS, New Delhi, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raju","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Radiology, AIIMS, New Delhi, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanjeev","family":"Sinha","sequence":"additional","affiliation":[{"name":"Department of Medicine, AIIMS, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Shalimar","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, AIIMS, New Delhi, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benu","family":"Dhawan","sequence":"additional","affiliation":[{"name":"Department of Microbiology, AIIMS, New Delhi, India;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Gastroenterol Clin North Am","first-page":"1145","article-title":"Diagnosis and management of cholecystitis and cholangitis","volume":"32","author":"Yusoff","year":"2003"},{"key":"b2","series-title":"Med Clin North Am","first-page":"1015","article-title":"Biliary tract emergencies. Acute cholecystitis, acute cholangitis, and acute pancreatitis","volume":"77","author":"Kadakia","year":"1993"},{"key":"b3","series-title":"N Engl J Med","first-page":"1582","article-title":"Endoscopic biliary drainage for severe acute cholangitis","volume":"326","author":"Lai","year":"1992"},{"key":"b4","series-title":"J Hepatobiliary Pancreat Surg","first-page":"15","article-title":"Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines","volume":"14","author":"Kimura","year":"2007"},{"key":"b5","series-title":"Gastrointest Endosc","first-page":"207","article-title":"ASGE guideline on the management of cholangitis","volume":"94","author":"Buxbaum","year":"2021"},{"key":"b6","series-title":"Lancet","first-page":"1307","article-title":"Urgent endoscopic drainage for acute suppurative cholangitis","volume":"1","author":"Leung","year":"1989"},{"key":"b7","series-title":"Dig Dis Sci","first-page":"1872","article-title":"Bile culture may guide antibiotic stewardship in acute bacterial cholangitis","volume":"69","author":"George","year":"2024"},{"key":"b8","series-title":"Endosc Int Open","first-page":"E307","article-title":"Association of short-course antimicrobial therapy and bacterial resistance in acute cholangitis: Retrospective cohort study","volume":"12","author":"Masuda","year":"2024"},{"key":"b9","series-title":"J Hepatobiliary Pancreat Surg","first-page":"59","article-title":"Antimicrobial therapy for acute cholangitis: Tokyo Guidelines","volume":"14","author":"Tanaka","year":"2007"},{"key":"b10","series-title":"Surg Infect (Larchmt)","first-page":"105","article-title":"Microbiology and antibiotic susceptibility of organisms in bile cultures from patients with and without cholangitis at an Asian academic medical center","volume":"12","author":"Salvador","year":"2011"},{"key":"b11","series-title":"J Clin Med","first-page":"2697","article-title":"Antibiotic administration within two days after successful endoscopic retrograde cholangiopancreatography is sufficient for mild and moderate acute cholangitis","volume":"11","author":"Masuda","year":"2022"},{"key":"b12","series-title":"Dig Dis Sci","first-page":"4128","article-title":"Antibiotic therapy of 3 days may be sufficient after biliary drainage for acute cholangitis: A systematic review","volume":"66","author":"Haal","year":"2021"},{"key":"b13","series-title":"Gastroenterol Nurs","first-page":"404","article-title":"Standards of infection prevention in reprocessing flexible gastrointestinal endoscopes","volume":"39","author":"Herrin","year":"2016"},{"key":"b14","article-title":"CLSI Guidelines.","year":"2026"},{"key":"b15","series-title":"Selected Papers of Hirotugu Akaike","author":"Akaike","year":"1998"},{"key":"b16","series-title":"J Hepatobiliary Pancreat Sci","first-page":"310","article-title":"Updated comprehensive epidemiology, microbiology, and outcomes among patients with acute cholangitis","volume":"24","author":"Gomi","year":"2017"},{"key":"b17","series-title":"Indian J Surg","first-page":"479","article-title":"Bacteriological spectrum in bile and outcomes in patients of acute bacterial cholangitis","volume":"87","author":"Singh","year":"2024"},{"key":"b18","series-title":"Infect","first-page":"253","article-title":"Biliary tract infections and their microbiological spectrum \u2013 A study from coastal region of Southern India","volume":"23","author":"Mamatha","year":"2019"},{"key":"b19","series-title":"Indian J Gastroenterol","first-page":"204","article-title":"Microbial profile and antibiotic sensitivity pattern in acute bacterial cholangitis","volume":"30","author":"Sahu","year":"2011"},{"key":"b20","series-title":"Clin Endosc","first-page":"155","article-title":"Extended spectrum-\u03b2-lactamase or carbapenemase producing bacteria isolated from patients with acute cholangitis","volume":"45","author":"Goo","year":"2012"},{"key":"b21","series-title":"Endoscopy","first-page":"1045","article-title":"Microbiology of bile aspirates obtained at ERCP in patients with suspected acute cholangitis","volume":"54","author":"Gromski","year":"2022"},{"key":"b22","series-title":"Gastrointest Endosc","first-page":"885","article-title":"Microbiology of bile in patients with cholangitis or cholestasis with and without plastic biliary endoprosthesis","volume":"56","author":"Rerknimitr","year":"2002"},{"key":"b23","series-title":"Gastroenterol Res Pract","first-page":"1527328","article-title":"Microbial profiles and risk factors of preexisting biliary infection in patients with therapeutic endoscopy","volume":"2019","author":"Ruan","year":"2019"},{"key":"b24","series-title":"J Indira Gandhi Inst Med Sci","first-page":"23","article-title":"Analysis of bile culture for bacteriological profile and its antibiotics sensitivity pattern in patients undergoing ERCP","volume":"1","author":"Amarendra","year":"2015"},{"key":"b25","series-title":"Dig Dis","first-page":"155","article-title":"Endoscopic retrograde cholangio-pancreatography-obtained bile culture can guide antibiotic therapy in acute cholangitis","volume":"37","author":"Chandra","year":"2019"},{"key":"b26","series-title":"J Gastroenterol Hepatol","first-page":"935","article-title":"Endoscopic retrograde cholangiopancreatography-obtained bile culture in acute cholangitis: Retrospective analysis of bile cultures and risk factors in a tertiary care center","volume":"39","author":"Stathopoulos","year":"2024"},{"key":"b1","series-title":"Gastroenterol Clin North Am","first-page":"1145","article-title":"Diagnosis and management of cholecystitis and cholangitis","volume":"32","author":"Yusoff","year":"2003"},{"key":"b2","series-title":"Med Clin North Am","first-page":"1015","article-title":"Biliary tract emergencies. Acute cholecystitis, acute cholangitis, and acute pancreatitis","volume":"77","author":"Kadakia","year":"1993"},{"key":"b3","series-title":"N Engl J Med","first-page":"1582","article-title":"Endoscopic biliary drainage for severe acute cholangitis","volume":"326","author":"Lai","year":"1992"},{"key":"b4","series-title":"J Hepatobiliary Pancreat Surg","first-page":"15","article-title":"Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines","volume":"14","author":"Kimura","year":"2007"},{"key":"b5","series-title":"Gastrointest Endosc","first-page":"207","article-title":"ASGE guideline on the management of cholangitis","volume":"94","author":"Buxbaum","year":"2021"},{"key":"b6","series-title":"Lancet","first-page":"1307","article-title":"Urgent endoscopic drainage for acute suppurative cholangitis","volume":"1","author":"Leung","year":"1989"},{"key":"b7","series-title":"Dig Dis Sci","first-page":"1872","article-title":"Bile culture may guide antibiotic stewardship in acute bacterial cholangitis","volume":"69","author":"George","year":"2024"},{"key":"b8","series-title":"Endosc Int Open","first-page":"E307","article-title":"Association of short-course antimicrobial therapy and bacterial resistance in acute cholangitis: Retrospective cohort study","volume":"12","author":"Masuda","year":"2024"},{"key":"b9","series-title":"J Hepatobiliary Pancreat Surg","first-page":"59","article-title":"Antimicrobial therapy for acute cholangitis: Tokyo Guidelines","volume":"14","author":"Tanaka","year":"2007"},{"key":"b10","series-title":"Surg Infect (Larchmt)","first-page":"105","article-title":"Microbiology and antibiotic susceptibility of organisms in bile cultures from patients with and without cholangitis at an Asian academic medical center","volume":"12","author":"Salvador","year":"2011"},{"key":"b11","series-title":"J Clin Med","first-page":"2697","article-title":"Antibiotic administration within two days after successful endoscopic retrograde cholangiopancreatography is sufficient for mild and moderate acute cholangitis","volume":"11","author":"Masuda","year":"2022"},{"key":"b12","series-title":"Dig Dis Sci","first-page":"4128","article-title":"Antibiotic therapy of 3 days may be sufficient after biliary drainage for acute cholangitis: A systematic review","volume":"66","author":"Haal","year":"2021"},{"key":"b13","series-title":"Gastroenterol Nurs","first-page":"404","article-title":"Standards of infection prevention in reprocessing flexible gastrointestinal endoscopes","volume":"39","author":"Herrin","year":"2016"},{"key":"b14","article-title":"CLSI Guidelines.","year":"2026"},{"key":"b15","series-title":"Selected Papers of Hirotugu Akaike","author":"Akaike","year":"1998"},{"key":"b16","series-title":"J Hepatobiliary Pancreat Sci","first-page":"310","article-title":"Updated comprehensive epidemiology, microbiology, and outcomes among patients with acute cholangitis","volume":"24","author":"Gomi","year":"2017"},{"key":"b17","series-title":"Indian J Surg","first-page":"479","article-title":"Bacteriological spectrum in bile and outcomes in patients of acute bacterial cholangitis","volume":"87","author":"Singh","year":"2024"},{"key":"b18","series-title":"Infect","first-page":"253","article-title":"Biliary tract infections and their microbiological spectrum \u2013 A study from coastal region of Southern India","volume":"23","author":"Mamatha","year":"2019"},{"key":"b19","series-title":"Indian J Gastroenterol","first-page":"204","article-title":"Microbial profile and antibiotic sensitivity pattern in acute bacterial cholangitis","volume":"30","author":"Sahu","year":"2011"},{"key":"b20","series-title":"Clin Endosc","first-page":"155","article-title":"Extended spectrum-\u03b2-lactamase or carbapenemase producing bacteria isolated from patients with acute cholangitis","volume":"45","author":"Goo","year":"2012"},{"key":"b21","series-title":"Endoscopy","first-page":"1045","article-title":"Microbiology of bile aspirates obtained at ERCP in patients with suspected acute cholangitis","volume":"54","author":"Gromski","year":"2022"},{"key":"b22","series-title":"Gastrointest Endosc","first-page":"885","article-title":"Microbiology of bile in patients with cholangitis or cholestasis with and without plastic biliary endoprosthesis","volume":"56","author":"Rerknimitr","year":"2002"},{"key":"b23","series-title":"Gastroenterol Res Pract","first-page":"1527328","article-title":"Microbial profiles and risk factors of preexisting biliary infection in patients with therapeutic endoscopy","volume":"2019","author":"Ruan","year":"2019"},{"key":"b24","series-title":"J Indira Gandhi Inst Med Sci","first-page":"23","article-title":"Analysis of bile culture for bacteriological profile and its antibiotics sensitivity pattern in patients undergoing ERCP","volume":"1","author":"Amarendra","year":"2015"},{"key":"b25","series-title":"Dig Dis","first-page":"155","article-title":"Endoscopic retrograde cholangio-pancreatography-obtained bile culture can guide antibiotic therapy in acute cholangitis","volume":"37","author":"Chandra","year":"2019"},{"key":"b26","series-title":"J Gastroenterol Hepatol","first-page":"935","article-title":"Endoscopic retrograde cholangiopancreatography-obtained bile culture in acute cholangitis: Retrospective analysis of bile cultures and risk factors in a tertiary care center","volume":"39","author":"Stathopoulos","year":"2024"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/114\/5\/article-p832.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/114\/5\/article-p832.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/114\/5\/article-p832.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T15:37:45Z","timestamp":1778081865000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/114\/5\/article-p832.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,6]]},"references-count":52,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.25-0488","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,6]]}}}