ABSTRACT Background Enterococci are commonly isolated from bile cultures in patients with acute cholangitis (AC) and pose a global concern owing to antibiotic resistance. This study identified predictive factors and clinical characteristics of AC with enterococcal‐positive bile cultures. Methods Consecutive patients with AC and bactobilia who underwent endoscopic retrograde cholangiopancreatography between April 2022 and March 2024 were included. Patients were categorized into enterococcal (E) and non‐E groups based on bile culture results. Predictive factors for enterococcal positivity were analyzed. Empirical antibiotic coverage and clinical outcomes (symptom duration, length of antibiotic therapy, in‐hospital mortality, and short‐term recurrence) were compared within all‐grade and severe AC. Results Among 250 patients, 100 with enterococcal‐positive bile cultures formed the E group. Predictive factors included age > 71 years, immunosuppressed status, prior endoscopic sphincterotomy, and prior biliary stenting. Inappropriate empirical antibiotic coverage was more frequent in the E group across both severity categories. Clinical outcomes did not differ among all‐grade patients except for higher short‐term recurrence in the E group. No significant differences were observed among severe patients for any clinical outcome. Conclusions Enterococcal‐positive bile cultures are predicted by specific factors. Despite frequent inadequate empirical antibiotic coverage, most clinical outcomes were similar to those for non‐enterococcal patients.
Kaneko et al. (2025) studied this question.