title: Microbiological analysis of bile and its impact in critically ill patients with secondary sclerosing cholangitis.
abstract: OBJECTIVE
  Secondary sclerosing cholangitis in critically ill patients (SSC-CIP) is an emerging disease entity with unfavourable outcome. Our aim was to analyze the microbial spectrum in bile of patients with SSC-CIP and to evaluate the potential impact on the empiric antibiotic treatment in these patients.
  
  
  METHODS
  169 patients (72 patients with SSC-CIP and 97 patients with primary sclerosing cholangitis (PSC)) were included in a prospective observational study between 2010 and 2013. Bile was obtained during endoscopic retrograde cholangiography (ERC) and microbiologically analyzed.
  
  
  RESULTS
  Patients with SSC displayed a significantly different microbiological profile in bile. Enterococcus faecium, Pseudomonas aeruginosa and non-albicans species of Candida were more frequent in SSC compared to patients with PSC (p < 0.05). Patients with SSC showed a higher incidence of drug or multi-drug resistant organisms in bile (p = 0.001). The antimicrobial therapy was adjusted in 64% of patients due to resistance or presence of microorganisms not covered by the initial therapy regimen.
  
  
  CONCLUSIONS
  Patients with SSC-CIP have a distinct microbial profile in bile. Difficult to treat organisms are frequent and an ERC with bile fluid collection for microbiological analysis should be considered in case of insufficient antimicrobial treatment.
authors: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
authors: Torsten
authors: T
authors: Voigtländer
authors: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
authors: Ensieh
authors: E
authors: Leuchs
authors: Institute of Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany.
authors: Ralf-Peter
authors: RP
authors: Vonberg
authors: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
authors: Philipp
authors: P
authors: Solbach
authors: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
authors: Michael P
authors: MP
authors: Manns
authors: Institute of Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany.
authors: Sebastian
authors: S
authors: Suerbaum
authors: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany. Electronic address: lankisch.tim@mh-hannover.de.
authors: Tim O
authors: TO
authors: Lankisch
mesh_terms: D000328:Adult; D001646:Bile / Q000382:microbiology*; D002175:Candida / Q000302:isolation & purification*; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D016638:Critical Illness; D024881:Drug Resistance, Bacterial; D016984:Enterococcus faecium / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*; D013997:Time Factors
keywords: Bile; Critically ill patients; Microbiology; Multi drug resistance; Primary sclerosing cholangitis; Secondary sclerosing cholangitis