title: Bile duct bacterial isolates in primary sclerosing cholangitis: a study of explanted livers.
abstract: OBJECTIVE
  The pathogenesis of the inflammatory lesion in primary sclerosing cholangitis is unknown. The clinical picture is characterized by i.a. episodes of fever, the cause of which also remains speculative. Previous studies of bacterial isolates in the liver or bile ducts in primary sclerosing cholangitis have had the shortcoming of possible contamination associated with the sampling. The aim of this study was to investigate whether bile and bile duct tissue, obtained under sterile conditions in connection with liver transplantation, contain bacteria.
  
  
  METHODS
  We studied bile from bile duct walls and bile collected from the explanted livers of 36 patients with primary sclerosing cholangitis and 14 patients with primary biliary cirrhosis.
  
  
  RESULTS
  Positive cultures were obtained from 21 of 36 primary sclerosing cholangitis patients, but from none of the primary biliary cirrhosis patients. The number of bacterial strains was inversely related to the time after the last endoscopic retrograde cholangiography. Treatment with antibiotics or intraductal stent, or the occurrence of fever before liver transplantation did not seem to influence the culture results, whereas antibiotic treatment in connection with endoscopic retrograde cholangiography may possibly have reduced the number of isolates in the cultures. Alpha-haemolytic Streptococci were retrieved as late as 4 years after the last endoscopic retrograde cholangiography. Retrospective analysis of liver laboratory tests after endoscopic retrograde cholangiography did not indicate a deleterious effect of the investigation.
  
  
  CONCLUSIONS
  The data suggest that antibiotics should be given routinely in connection with endoscopic retrograde cholangiography. They also raise the question of a possible role of alpha-haemolytic Streptococci in the progression of primary sclerosing cholangitis.
authors.affiliation: Department of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: R
authors.initials: R
authors.lastname: Olsson
authors.forename: E
authors.initials: E
authors.lastname: Björnsson
authors.forename: L
authors.initials: L
authors.lastname: Bäckman
authors.forename: S
authors.initials: S
authors.lastname: Friman
authors.forename: K
authors.initials: K
authors.lastname: Höckerstedt
authors.forename: B
authors.initials: B
authors.lastname: Kaijser
authors.forename: M
authors.initials: M
authors.lastname: Olausson
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000517:prevention & control; D001646:Bile / Q000382:microbiology; D001652:Bile Ducts / Q000382:microbiology*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000382:microbiology* / Q000601:surgery; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D008099:Liver / Q000382:microbiology*; D008105:Liver Cirrhosis, Biliary / Q000382:microbiology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents