*Purpose: The signs and symptoms of biliary infection in liver transplantation (LT) recipients are frequently subtle because of immunosuppression, thereby delaying its diagnosis and increasing the risk of its progression to bacteremia. However, the bile microbiology and antibiotic susceptibilities of LT recipients with biliary infection are rarely studied that antibiotics recommended for the non-transplant population were commonly used and sometimes, they are not effectively control the infection. Therefore, we aimed to compare its differences between LT recipients and the non-transplant population.

*Methods: A total of 376 positive bile cultures between LT recipients with biliary complications (n=127, LT group) and the non-transplant population with acute cholecystitis (n=249, non-transplant group) hospitalized from January 2009 to December 2018 at multiple centers were investigated.

*Results: There were significant differences in the incidences of the following commonly isolated microorganisms between the LT and non-transplant groups (P < 0.001): Enterococcus (31.5% vs. 26.5%), Klebsiella (18.1% vs. 12.4%), Pseudomonas (14.2% vs. 4.0%), Escherichia (11.0% vs. 29.3%), and Enterobacter (3.9% vs. 8.4%). The incidences of the most frequently isolated microorganisms significantly changed over time after LT: Enterococcus (35.8%), Klebsiella (26.4%), and Pseudomonas (13.2%) within 6 months after LT; and Enterococcus (28.4%), Escherichia (17.6%), and Pseudomonas (14.2%) > 6 months after LT (P = 0.029). Many of the commonly used antibiotics showing good effectiveness in the non-transplant group provided inadequate coverage for frequently encountered microorganisms in the LT group, except for amikacin and imipenem against commonly isolated gram-negative microorganisms and linezolid, streptomycin, and teicoplanin against gram-positive Enterococcus.

*Conclusions: Differences in the bile microbiology and antibiotic susceptibilities between LT recipients and the non-transplant population should be considered before selecting antibiotics for acute biliary infection.

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