Bacteriology of acute obstructive suppurative cholangitis of the aged

Bacteriological examination was performed on bile from 23 patients with acute obstructive suppurative cholangitis. Of 23 bile cultures, 15 yielded aerobic and anaerobic bacteria and 8 yielded aerobic bacteria only. No specimen grew anaerobic bacteria only. A total of 20 cultures yielded a polymicrobial flora, and 3 cultures grew one single aerobic bacterium. Escherichia coli, Klebsiella sp., enterococci, Bacteroids fragilis, and Clostridium perfringens were the predominant bacterial flora in bile of these patients. Bacteremia was documented in 10 of the 12 patients cultured. All bacteremias involved aerobic bacteria and were polymicrobial in three patients. The frequent presence of anaerobes in bile of patients with acute obstructive suppurative cholangitis suggests that antimicrobial therapy should provide adequate coverage for anaerobic bacteria and enteric organisms.