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3)Department of Microbiology, Juntendo University, Graduate School of Medicine, Tokyo, Japan2)Department of Microbiome Research, Juntendo University Graduate School of Medicine, Tokyo, Japan4)Department of Human Pathology, Juntendo University, Graduate School of Medicine, Tokyo, Japan5)Department of Clinical Laboratory, Juntendo University, Graduate School of Medicine, Tokyo, Japan6)Department of Infection Metagenomics, Genome Information Research Center, Research Institute for Masaaki MINAGAWA1, 2), Teruo KIRIKAE3), Mari TOHYA3), Shota NAKAMURA6), Tetsuya IIDA6), Akio SAIURA1), Shin WATANABE2)The Impact of Metagenomic AnalysisCorresponding author: Shin WatanabeDepartment of Microbiome Research, Juntendo University Graduate School of Medicine2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, JapanTEL: +81-3-3813-3111　E-mail: snwatana@juntendo.ac.jp〔Received　Nov. 24, 2021〕〔Accepted　Feb. 8, 2022〕J-STAGE Advance published date: Jun. 20, 2022Copyright © 2022 The Juntendo Medical Society. This is an open access article distributed under the terms of Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original source is properly credited. doi: 10.14789/jmj.JMJ21-0046-CRBackground: Escherichia coli is thought to cause xanthogranulomatous cholecystitis (XGC). However, it is unclear whether other pathogens are associated with the cause and progression of XGC.Case presentation: Patient 1 was a 55-year-old man with a previous surgical history of right lung cancer. He presented with abdominal pain and was diagnosed with acute cholecystitis. He underwent endoscopic nasogallbladder drainage (ENGBD), antimicrobial therapy, and endoscopic sphincterotomy (EST). He underwent cholecystectomy on day 59. The patient was pathologically diagnosed with chronic phase XGC. Acinetobacter baumannii was isolated from the bile sample during the operation. Patient 2 was a 58-year-old man with no previous medical history. He presented with abdominal pain and was diagnosed with acute cholecystitis. He underwent endoscopic retrograde biliary drainage (ERGBD) and antimicrobial therapy. His symptoms improved, but acute cholecystitis became exacerbated on day 53. The patient was treated with antimicrobial therapy. He underwent cholecystectomy on day 88. The patient was pathologically diagnosed with focal acute inflammatory phase XGC. Staphylococcus capitis was isolated from the bile during the operation. This study describes two patients with XGC, one infected with A. baumannii and the other with S. capitis, in their gallbladders, which was identified by bacterial culture. Metagenomic analysis revealed that the genera Acinetobacter and Staphylococcus predominated and that other genera, including Delftia and Anaerobacillus, were also present, suggesting that these bacteria play a significant role in the pathological changes associated with XGC.Conclusions: This is the first report of A. baumannii and S. capitis infections in patients with XGC.Key words: xanthogranulomatous cholecystitis, Acinetobacter baumannii, Staphylococcus capitis, metagenomic analysisJuntendo Medical Journal2022. 68(3), 282-288Case ReportsDetection of Acinetobacter Baumannii and Staphylococcus Capitis in Bile from Two Patients with Chronic Xanthogranulomatous Cholecystitis: 1)Department of Hepatobiliary-Pancreatic Surgery, Juntendo University, Graduate School of Medicine, Tokyo, JapanMicrobial Diseases, Osaka University, Suita, JapanYuki FUKUMURA4), Ayako NAKAMURA5), Daisuke MOTOOKA6), 282