CLINICAL FACTORS ASSOCIATED WITH POSITIVE BILE CULTURES DURING PRIMARY PERCUTANEOUS BILIARY DRAINAGE

PURPOSE: To evaluate the utility of routine bile cultures and to deter mine the risk factors for bacterial colonization of the bile as well a s the biliary flora in patients with biliary obstruction undergoing pr imary percutaneous biliary drainage, MATERIALS AND METHODS: Between Oc tober 1995 and January 1997, bile cultures were prospectively obtained in all patients undergoing percutaneous biliary drainage, Seventy-six patients underwent 86 procedures. Culture results were correlated wit h clinical, laboratory, and demographic variables. The antibiotic sens itivities of cultured organisms mere examined, RESULTS: Fever, previou s endoscopic or percutaneous biliary instrumentation, and bilioenteric anastomosis were significant predictors of a positive bile culture. I n the absence of any of these indicators, bile cultures were unlikely to be positive. Enterococcus species was the organism isolated most co mmonly, Yeast, gram-negative aerobic bacilli, and Streptococcus virida ns followed in frequency. CONCLUSION: Bile cultures provide valuable i nformation that was useful for planning antibiotic prophylaxis and tre atment. The likelihood of positive bile cultures can be predicted base d on certain clinical variables, Continued investigation is needed to better predict bacterial flora in individual patients. Given the assoc iation between previous instrumentation and biliary colonization, noni nvasive imaging modalities should be exhausted before invasive procedu res are performed for solely diagnostic purposes in patients with bili ary obstruction.