S2295 EUS-Gallbladder Drainage-Assisted Assessment of Microbial Profile in Patients With Cholecystitis: A Multicentered Experience

Introduction: Endoscopic Ultrasound gallbladder drainage (EUS-GBD) is now used for the management of patients with cholecystitis who are not appropriate surgical candidates. In practice, empiric, broad-spectrum antibiotics are used in the treatment of cholecystitis; however, this is based on data from several decades ago. Methods: We aimed to generate an updated microbial from sampled fluid within the gallbladder in non-surgical patients with cholecystitis undergoing EUS-GBD. Retrospective analysis was conducted from prospectively collected data. Results: Sixty-one patients underwent EUS-GBD at our 5-hospital system. Of these, 45 patients (73.8%) underwent fine needle aspiration of gallbladder contents, and subsequent cultures were performed on aspirated fluid. After microbiology review, reliable cultures were confirmed in 25 patients (55.6%). Isolated bacteria included: Escherichia coli (26.7%; 1 patient with extended spectrum beta-lactamase variant), Enterococcus faecalis (22.2%; 3 with vancomycin-resistance), Streptococcal species (15.6%), Klebsiella pneumoniae (11.1%; one with multi-drug resistance), Pseudomonas aeruginosa (11.1%), Enterobacter cloacae (4.4%), Methicillin-Resistant Staphylococcus aureus (4.4%), Serratia marcescens (2.2%). Isolated fungal species included: Candida albicans (17.8%), Candida glabrata (4.4%), and Candida tropicalis (2.2%). There was no difference in clinical outcomes in patients with reliable culture results as compared to those found to have contaminant (20 patients, 44.4%); compared to those with no growth on culture (3 patients, 6.7%); nor compared to those who did not have cultures obtained (16 patients). There was no difference in likelihood of a reliable culture with transantral versus transduodenal sampling (P = 0.7). There was no recurrence of cholecystitis in any patient who underwent EUS-GBD. Conclusion: Updated culture data from intact gallbladders in the setting of active cholecystitis is now available based on this study and differ, somewhat to previously published data.