Dilated common bile duct diameter as an indicator of bacteremia in patients with symptomatic common bile duct stones

The optimal timing and selection for blood culture collection in patients with acute cholangitis remains unclear. The relationship between common bile duct (CBD) diameter and the incidence of bacteremia in patients with CBD stones was elucidated.

This single-center retrospective observational study included patients with symptomatic CBD stones who presented to the emergency department between January 2019 and December 2021. The primary endpoint was the incidence of bacteremia. The patients were divided into two groups based on bacteremia complications. The patient characteristics and CBD diameters were compared between the two groups to identify factors associated with bacteremia.

In total, 270 patients were analyzed, with bacteremia identified in 134 patients (50 %), and the median CBD diameter was 10.7 mm (IQR, 8.7-13.7). The CBD diameter was significantly larger in patients with bacteremia (median 12.4 mm [IQR, 9.9-15.7] vs. 9.7 mm [IQR, 8.2-11.7], P < 0.001) in univariate analysis. Multivariable analysis revealed that the CBD diameter was significantly associated with bacteremia (OR: 1.25, 95 % CI: 1.14-1.38, P < 0.010). The area under the ROC curves, representing the diagnostic accuracy of CBD diameter for indicating bacteremia, was 0.72 (95 % CI, 0.66-0.78) with a cut-off value of 11.2 mm.

CBD dilation in patients with symptomatic CBD stones is significantly correlated with bacteremia. The CBD diameter cannot be assessed as the sole tool for detecting bacteremia; however, CBD dilation could be an indicator of bacteremia, assisting in the treatment strategy, regardless of the initial severity of cholangitis.