Do the Results of Bile Cultures Affect the Outcomes of Patients with Mild-to-Moderate Ascending Cholangitis? A Single Center Prospective Study

<b>Background/Objectives:</b> Bile cultures are recommended in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). We sought to evaluate if bile cultures affect the outcomes of patients with mild-to-moderate ascending cholangitis. <b>Methods:</b> Bile cultures were prospectively obtained from patients undergoing ERCP between 2021 and 2023 at a single gastroenterology unit. The primary outcome was the prognosis of patients with mild-to-moderate ascending cholangitis who received appropriate antibiotic coverage with empiric antibiotics versus those with bacteria resistant to the empiric antibiotics. Additionally, outcomes between those with positive and negative biliary cultures were assessed. <b>Results:</b> One hundred sixty ERCPs were conducted, including 65 (40%) for ascending cholangitis with a naive papilla. Of these, 43 (66.2%) had a positive bile culture. Fourteen (32.6%) described mixed bacteria. <i>Enterococcus</i> spp. was the most common bacteria (22, 51.2%), followed by <i>E. coli</i> (17, 39.6%). Patients that were treated with appropriate antibiotics had similar outcomes compared to those who received inappropriate antibiotics per bile culture susceptibilities in terms of length of hospitalization (7.8 days vs. 7.9 days), in-hospital mortality, 30-day readmissions, and 30-day mortality (<i>p</i> ≥ 0.21, ns). There were also no differences in those outcomes between patients with positive and negative bile cultures (<i>p</i> ≥ 0.09, ns). <b>Conclusions:</b> These results question the need for obtaining bile cultures in every ERCP performed, including those with cholangitis. They imply that decompression of the biliary tree during ERCP is the more significant aspect of treatment, rather than the selection of an appropriate antibiotic regimen. Additional studies are needed to assess the benefits of acquiring bile cultures in all cases of ascending cholangitis.