{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T04:54:36Z","timestamp":1791089676955,"version":"4.1.0"},"reference-count":32,"publisher":"King Faisal Specialist Hospital and Research Centre","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ann Saudi Med"],"published-print":{"date-parts":[[2026,9]]},"abstract":"\n BACKGROUND:<\/jats:title>\n Organisms cultured from bile in biliary tract infection, and their resistance, vary widely between settings, and pooled estimates to guide empirical therapy are lacking.<\/jats:p>\n <\/jats:sec>\n \n OBJECTIVE:<\/jats:title>\n Estimate bile-culture yield, organism distribution, and resistance.<\/jats:p>\n <\/jats:sec>\n \n DESIGN:<\/jats:title>\n Systematic review and random-effects meta-analysis of PubMed and reference lists<\/jats:p>\n <\/jats:sec>\n \n SETTING:<\/jats:title>\n Reports spanned nine countries across Asia, Europe, Africa, and North America<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n We extracted ductal-bile culture data from observational studies published from 2015 to 2025 of biliary infection\/cholangitis; noninfectious, gall bladder-only, microbiome-only, and nonextractable reports were excluded. DerSimonian\u2013Laird models, subgroup analysis, and JBI appraisal were used.<\/jats:p>\n <\/jats:sec>\n \n MAIN OUTCOME MEASURE:<\/jats:title>\n Culture yield; secondary organism proportions and resistance.<\/jats:p>\n <\/jats:sec>\n \n SAMPLE SIZE:<\/jats:title>\n 5147 patients (97% retrospective; 3% prospective); organisms: 35 267 observations.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n \n Yield was 77.3% (95% CI, 67.8\u201384.6); Gram-negative organisms 69.8% (65.6\u201373.7),\n E. coli<\/jats:italic>\n , 27.4% (23.5\u201331.7),\n K. pneumoniae<\/jats:italic>\n , 14.1% (12.3\u201316.2).\n <\/jats:p>\n <\/jats:sec>\n \n HETEROGENEITY:<\/jats:title>\n \n I\n 2<\/jats:sup>\n =86.0%\u201397.7%; all\n P<\/jats:italic>\n <.001.\n <\/jats:p>\n <\/jats:sec>\n \n RISK OF BIAS:<\/jats:title>\n Fourteen reports were low risk, two moderate; exclusions minimally changed estimates.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSION:<\/jats:title>\n \n Bile-culture yield was high and Gram-negative organisms, particularly\n E. coli<\/jats:italic>\n and\n K. pneumoniae<\/jats:italic>\n , predominated, but estimates were highly heterogeneous and resistance could not be pooled; culture-directed therapy guided by local antibiograms is therefore preferable to a universal empirical regimen.\n <\/jats:p>\n <\/jats:sec>\n \n LIMITATIONS:<\/jats:title>\n PubMed-only\/open-access search, retrospective designs, inconsistent definitions, one dominant dataset.<\/jats:p>\n <\/jats:sec>\n \n REGISTRATION:<\/jats:title>\n \n Retrospectively registered on OSF (89wqs; DOI:\n 10.17605\/OSF.IO\/89WQS<\/jats:ext-link>\n ).\n <\/jats:p>\n <\/jats:sec>","DOI":"10.5144\/0256-4947.2026.388","type":"journal-article","created":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T04:44:41Z","timestamp":1791089081000},"page":"388-403","source":"Crossref","is-referenced-by-count":0,"title":["Microbiology and antimicrobial resistance in biliary tract infections including acute and post-ERCP cholangitis: a systematic review and meta-analysis"],"prefix":"10.5144","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0026-0841","authenticated-orcid":true,"given":"Ahmed","family":"Salman","sequence":"first","affiliation":[{"name":"From the Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Abdallah","family":"Salman","sequence":"additional","affiliation":[{"name":"From the General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egpyt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Abdallah","sequence":"additional","affiliation":[{"name":"From the General Surgery Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Elewa","sequence":"additional","affiliation":[{"name":"From the Department of General Surgery, The European Medical Center, Jeddah, Saudi Arabiah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Marwan","sequence":"additional","affiliation":[{"name":"From the Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3134","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2016.06.051"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/MS9.0000000000002169"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics15050445"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics15243095"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.37652\/juaps.2025.166452.1794"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jiph.2024.102544"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2011.03570.x"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/XEB.0000000000000054"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/0197-2456(86)90046-2"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2013-203104"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1055\/a-1790-1314"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v26.i14.1638"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/9255444"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/gastro\/goae010"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.2147\/IDR.S474191"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2024.1404366"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.22037\/ghfbb.v18i4.3154"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.4103\/jfmpc.jfmpc_670_23"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-020-01201-6"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0169900"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.3390\/life13112205"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.3390\/diseases12010019"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics14070679"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.1002\/jgh3.12937"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/1026254"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v21.i24.7506"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.518"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.1177\/2050640620915016"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000002495"},{"key":"e_1_3_5_32_2","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000002229"},{"key":"e_1_3_5_33_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-022-07441-8"}],"container-title":["Annals 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