Comparison of pathogen patterns in benign and malignant obstruction in cholangitis patients: A systematic review
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Ahmad Fathi Fuadi 1 2 * , Ignatius Riwanto 2 3 , Sigit Adi Prasetyo 2 3 , Reza Aditya Afriansyah 4
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1 Doctoral Study Program of Medical and Health Science, Universitas Diponegoro, Semarang, INDONESIA2 Digestive Division, Department of Surgery, Dr. Kariadi General Hospital, Semarang, INDONESIA3 Department of Surgery, Faculty of Medicine, Universitas Diponegoro, Semarang, INDONESIA4 Department of Medicine, Faculty of Medicine, Universitas Diponegoro, Semarang, INDONESIA* Corresponding Author

Abstract

Background: Cholangitis is a serious bile duct infection caused by obstruction that permits bacterial growth and may progress to sepsis. Management includes antibiotics and biliary drainage, but selection is challenged by antibiotic resistance and differing pathogen patterns between benign and malignant obstruction. This systematic review aimed to compare the prevalence and distribution of pathogens identified in bile, blood, and biliary stent cultures between benign and malignant biliary obstruction in patients with cholangitis.
Methods: A systematic search of PubMed, Scopus, and ScienceDirect (January 1, 2014-October 17, 2024) identified cohort, case-control, and cross-sectional studies comparing microbial profiles in benign versus malignant cholangitis. Non-English articles, case reports, randomized trials, and reviews were excluded.
Results: Eight studies involving 3,575 patients were included. Culture positivity was generally higher in benign obstruction (bile 55.7% vs. 44.3%; blood 19.6% vs. 14.2%). Escherichia coli was most frequently isolated, followed by Enterococcus spp., Klebsiella pneumoniae, and Pseudomonas aeruginosa. Malignant cases more often yielded Candida spp. and viridans-group streptococci from stents.
Conclusion: Distinct pathogen patterns may inform empirical therapy, though further research is needed.

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Article Type: Review Article

ELECTRON J GEN MED, Volume 23, Issue 3, June 2026, Article No: em741

https://doi.org/10.29333/ejgm/18733

Publication date: 09 Jun 2026

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