Authors
Ahmed Salman, Mohamed Abdallah Salman, Ahmed Abdallah, Ahmed Elewa, Ahmed Marwan
Published in
Annals of Saudi medicine. Volume 46. Issue 5. Pages 388-403. Epub Oct 01, 2026.
Abstract
Organisms cultured from bile in biliary tract infection, and their resistance, vary widely between settings, and pooled estimates to guide empirical therapy are lacking.
Estimate bile-culture yield, organism distribution, and resistance.
Systematic review and random-effects meta-analysis of PubMed and reference lists.
Reports spanned nine countries across Asia, Europe, Africa, and North America.
We extracted ductal-bile culture data from observational studies published from 2015 to 2025 of biliary infection/cholangitis; noninfectious, gall bladder-only, microbiome-only, and nonextractable reports were excluded. DerSimonian-Laird models, subgroup analysis, and JBI appraisal were used.
Culture yield; secondary organism proportions and resistance.
5147 patients (97% retrospective; 3% prospective); organisms: 35 267 observations.
Yield was 77.3% (95% CI, 67.8-84.6); Gram-negative organisms 69.8% (65.6-73.7), E. coli, 27.4% (23.5-31.7), K. pneumoniae, 14.1% (12.3-16.2).
I2=86.0%-97.7%; all P<.001.
Fourteen reports were low risk, two moderate; exclusions minimally changed estimates.
Bile-culture yield was high and Gram-negative organisms, particularly E. coli and K. pneumoniae, predominated, but estimates were highly heterogeneous and resistance could not be pooled; culture-directed therapy guided by local antibiograms is therefore preferable to a universal empirical regimen.
PubMed-only/open-access search, retrospective designs, inconsistent definitions, one dominant dataset.
Retrospectively registered on OSF (89wqs; DOI: 10.17605/OSF.IO/89WQS).
PMID:
42829460
Bibliographic data and abstract were imported from PubMed on 04 Oct 2026.
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