Clinical Characteristics and Predictors of Acute Cholangitis With Enterococcal-Positive Bile Cultures: A Retrospective Study.

Background: Enterococci are commonly isolated from bile cultures in patients with acute cholangitis (AC) and pose a global concern owing to antibiotic resistance. This study identified predictive factors and clinical characteristics of AC with enterococcal-positive bile cultures.

Methods: Consecutive patients with AC and bactobilia who underwent endoscopic retrograde cholangiopancreatography between April 2022 and March 2024 were included. Patients were categorized into enterococcal (E) and non-E groups based on bile culture results. Predictive factors for enterococcal positivity were analyzed. Empirical antibiotic coverage and clinical outcomes (symptom duration, length of antibiotic therapy, in-hospital mortality, and short-term recurrence) were compared within all-grade and severe AC.

Results: Among 250 patients, 100 with enterococcal-positive bile cultures formed the E group. Predictive factors included age > 71 years, immunosuppressed status, prior endoscopic sphincterotomy, and prior biliary stenting. Inappropriate empirical antibiotic coverage was more frequent in the E group across both severity categories. Clinical outcomes did not differ among all-grade patients except for higher short-term recurrence in the E group. No significant differences were observed among severe patients for any clinical outcome.

Conclusions: Enterococcal-positive bile cultures are predicted by specific factors. Despite frequent inadequate empirical antibiotic coverage, most clinical outcomes were similar to those for non-enterococcal patients.