Obstructive biliary disease (OBD) is a common hospital diagnosis. Its primary cause is choledocholithiasis, followed by choledochal cysts, primary sclerosing cholangitis, cholangiocarcinoma, and pancreatic head cancer. When infection occurs in the context of OBD, it usually leads to cholangitis, predominantly involving Gram-negative bacteria from the intestinal tract. This condition is associated with significant morbidity and mortality.1, 2, 3, 4

Regarding management of OBD with cholangitis, current guidelines recommend early empirical antibiotic (AB) therapy, biliary drainage, and bile culture to guide AB therapy. However, culture sensitivity ranges from 28 to 93% and results usually take some days to be available, which limits its diagnostic utility when clinical decisions regarding antibiotic management need to be made in real time.5, 6

To date, there are few publications that address the dynamic and changing biliary tract microbiota, which varies by region and over time.7 Additionally, information on bacterial isolation, antibiotic susceptibility, and microbiological profile in biliary obstruction is scarce. Therefore, providing data on this topic could assist clinicians in offering more effective empirical antibiotic therapy in clinical cholangitis. This study aimed to evaluate the clinical and microbiological profile in obstructive biliary disease at a tertiary care academic center.