The role of dominant stenoses in bacterial infections of bile ducts in primary sclerosing cholangitis.
OBJECTIVE
Primary sclerosing cholangitis (PSC) is characterized by progressive fibrotic inflammation and strictures of the biliary system. We studied the role of dominant stenoses in bacterial biliary infections and the effect of routine antibiotic administration with cholangiography.


METHODS
A prospective clinical trial without blinding or randomization.


METHODS
The endoscopy unit in a university hospital.


METHODS
Fifty patients with PSC entered and finished the study.


METHODS
A total of 103 endoscopic retrograde cholangiographies (ERC) was performed in 37 PSC patients with dominant stenosis and 13 controls with PSC but no dominant stenosis. After selective cannulation of the bile duct, bile samples were obtained during each procedure. All patients received systemic antibiotic treatment with ciprofloxacin for one week after ERC.


RESULTS
Enteric bacteria were detected in the bile specimens of 15 out of 37 PSC patients (40.5%) with dominant stenosis but never in the absence of dominant stenosis (P=0.004). Positive cultures for enteric bacteria were associated with elevated serum C-reactive protein, high leukocyte counts in bile (P<0.05) and the deterioration of liver function assessed by increasing bilirubin levels during the follow-up period lasting a median of 7 months (P=0.06). Despite the high rate of susceptibility in vitro, ciprofloxacin treatment eradicated enteric bacteria in only two out of 12 cases.


CONCLUSIONS
Bacterial infection of the bile ducts with dominant stenosis is a frequent finding and may play a role in the progression of PSC. Short-course antibiotic treatment is not very effective in eradicating acteria from the bile ducts.
Pohl
Juergen
J
Department of Internal Medicine IV, Ruprechts Karls University, Heidelberg, Germany.
Ring
Axel
A
Stremmel
Wolfgang
W
Stiehl
Adolf
A
D019072:Antibiotic Prophylaxis; D001646:Bile / Q000382:microbiology; D001663:Bilirubin / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000097:blood / Q000382:microbiology* / Q000628:therapy; D002779:Cholestasis / Q000097:blood / Q000150:complications* / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000150:complications* / Q000517:prevention & control; D005500:Follow-Up Studies; D006801:Humans; D007958:Leukocyte Count; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies
D002097:C-Reactive Protein; D001663:Bilirubin