Eight-Year Retrospective Study of Microbiology and Clinical Outcomes in Culture-Positive Acute Cholangitis

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Acute cholangitis is a time-sensitive infection in which outcomes depend on early antimicrobials and biliary decompression. This study described laboratory patterns, culture results (blood and bile), and obstruction-related imaging/ERCP findings in patients with acute cholangitis.

Retrospective cohort study of hospitalized adults (January 2018-May 2025) meeting criteria for acute cholangitis including inflammation, cholestasis, imaging evidence of biliary obstruction, and positive blood or bile cultures.

From 1830 patients with ICD-10 code for acute cholangitis, 301 met inclusion criteria (mean age 70.1 years). Fever >38°C was present in 30.2%, while leukocytosis (WBC >10×10³/µL) occurred in 92.4% (median WBC 13.94×10³/µL). Cholestatic/hepatocellular abnormalities were frequent: alkaline phosphatase >180 U/L in 83.7% (median 371 U/L), ALT >50 U/L in 84.1% (median 130 U/L), and AST >50 U/L in 89.4% (median 147 U/L). Blood cultures were obtained in 98.7% and were positive in 89.7%; polymicrobial bacteremia occurred in 21.6%. The most common bloodstream organisms were Escherichia coli (31.9%) and Klebsiella pneumoniae (14.6%), with mixed growth reported in 21.6%. Bile cultures were obtained in 23.9% and were polymicrobial in 69.4%. Among patients with both blood and bile cultures positive (13.3% of the cohort), full concordance occurred in 20%, partial concordance in 50%, and discordance in 30%. ERCP was performed in 76.1%, with obstruction documented in 96.1% of ERCP cases.

Obstructive cholangitis in this cohort was characterized by high rates of bacteremia, frequent polymicrobial infection, and common ERCP-confirmed obstruction requiring intervention.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2155

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