The changing bacteriology of recurrent pyogenic cholangitis in Hong Kong

When the results of bile cultures of RPC patients, admitted to Queen Mary Hospital in 1973-74 and 1979-80, were analysed together with data obtained from the publication of previous investigators, a change in the bacteriology of the disease was noted. The percentage of RPC patients was affected by E. coli was on the decline while, in contrast, a higher percentage of patients was affected by the other enterobacteriaceae (especially Klebsiella spp. and Proteus spp.) and the non-glucose fermenters. Similarly anaerobes and mixed aerobic cultures were more frequent in our series than in earlier ones. Improvement in anaerobic laboratory methods is postulated to be the most probable reason for the rising incidence of anaerobes, while changes in the use of antibiotics could be a major factor for some of the trends noted among the aerobes. Irrespective of the reason for the change in bacteriology, due consideration should be given to its therapeutic implications in the management of patients with recurrent pyogenic cholangitis.