Microbiology of Acute Cholangitis and Cholecystitis and Antimicrobial Susceptibility

Background: Acute cholecystitis and cholangitis are life-threatening if not treated promptly. Empiric antibiotic therapy is crucial, relying on local studies of bile culture for guidance. Objective: To identify the microbiological and antibiotic susceptibilities of organisms in bile cultures of patients with acute cholangitis and cholecystitis. Materials and Methods: Adults diagnosed with acute cholangitis and/or cholecystitis at the Hospital Regional ISSSTE Puebla (2022-2023) underwent bile aspiration via laparoscopy or open surgery. Microorganisms were isolated from bile cultures and antibiograms were obtained. Patients were classified according to severity according to the Tokyo Guidelines 2018. Results: A total of 88 patients with bile cultures for cholangitis/cholecystitis were included. Fourteen percent of cultures showed no bacterial growth, and E. coli was the most common pathogen with significant antibiotic resistance. Multivariate analysis identified recent antimicrobial therapy (p <0.03), concomitant malignancy (p <0.001), and age >65 years (p <0.0001) as factors associated with resistant bacteria. Thirty-day mortality was 2.3%. Conclusions: Empirical antimicrobial therapy based on TG 2018 was effective across all severity grades.