• Torsten Voigtländer, Ensieh Leuchs, Ralf-Peter Vonberg, Philipp Solbach, Michael P Manns, Sebastian Suerbaum, and Tim O Lankisch.
• Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
• J. Infect. 2015 May 1; 70 (5): 483-90.

ObjectivesSecondary 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.Methods169 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.ResultsPatients 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.ConclusionsPatients 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.Copyright © 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

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