• Ron Skorochod, David Raveh, Yonit Wiener-Well, Bashar Fteiha, Shimon Shteingart, and Yitzhak Skorochod.
• Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel, Internal Medicine, Shaare Zedek Medical Center, Jerusalem, Israel.
• Isr Med Assoc J. 2022 Oct 1; 24 (10): 643-648.

BackgroundThe hepatobiliary system is a sterile micro-environment. Bacterial infection in this system is most commonly associated with anaerobes as well as gram-positive and gram-negative bacteria. Biliary infections with Staphylococcus aureus are poorly characterized.ObjectivesTo depict the clinical characteristics and outcome of patients with S. aureus infection of the hepatobiliary system.MethodsMedical records of patients with bile cultures positive for S. aureus from January 2006 to November 2020 were extracted from the computerized database of a hospital in Israel.ResultsWe analyzed the results of 28 cases that were found in the database. The mean age of study patients was 62.2 ± 19 years. Hypertension, dyslipidemia, chronic kidney disease, diabetes, and benign prostatic hypertrophy were the most common co-morbidities (57.1%, 32.1%, 25%, 25%, and 25%, respectively). Fourteen of the methicillin-resistant S. aureus (MRSA) bile cultures (82.3%) were a result of primary S. aureus biliary infections (no other source for S. aureus infection) and the remainder were of a secondary infection. Eight of the MRSA cultures (47.1%) were from hospital acquired infections. Increased hospital mortality in patients with S. aureus hepatobiliary infection was associated with hypertension (P = 0.04), bedridden status (P = 0.01), and nursing home residence (P = 0.003).ConclusionsHepatobiliary infection with S. aureus can manifest in a variety of ways. S. aureus should be especially considered in patients who are bedridden, present with hypertension, or live in nursing homes because of their association with in-hospital mortality resulting from this entity.

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