Prospective observational multicenter study to define a diagnostic algorithm for biliary candidiasis

• Published in: World journal of gastroenterology : WJG 2014-09, Vol.20 (34), p.12260-12268
• Main Authors: Lenz, Philipp, Eckelskemper, Franziska, Erichsen, Thomas, Lankisch, Tim, Dechêne, Alexander, Lubritz, Gabriele, Lenze, Frank, Beyna, Torsten, Ullerich, Hansjörg, Schmedt, Andre, Domagk, Dirk
• Format: Article
• Language: English
• Subjects: Adult; Aged; Algorithms; Antifungal Agents - therapeutic use; Bacteriological Techniques; Bile - microbiology; Biliary; Biopsy; Candida - drug effects; Candida - isolation & purification; candidiasis; Candidiasis - diagnosis; Candidiasis - drug therapy; Candidiasis - microbiology; Chi-Square Distribution; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis; Cholangitis - diagnosis; Cholangitis - drug therapy; Cholangitis - microbiology; Cholestasis - diagnosis; Cholestasis - drug therapy; Cholestasis - microbiology; Constriction, Pathologic; Critical Pathways; Feces - microbiology; Female; fungal; Germany; Humans; Invasive; Logistic Models; Male; Middle Aged; Mouth Mucosa - microbiology; Multivariate Analysis; Predictive Value of Tests; Prospective Study; Risk Factors; Tertiary Care Centers
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v20.i34.12260

AIM:To develop an algorithm to improve the diagnosis and treatment of patients with biliary candidiasis.METHODS:We performed a prospective study of 127patients who underwent endoscopic retrograde cholangiopancreatography,for various biliary disorders,at 3 tertiary referral centers in Germany from July 2011through July 2012(ClinicalTrials.gov:NCT01109550).Bile,buccal,and stool samples were collected.When indicated,endoscopic transpapillary bile duct biopsies were performed to clarify the etiology of bile duct strictures and to prove invasive fungal infections.RESULTS:Candida species were detected in 38 of the 127 bile samples(29.9%).By multivariate analysis patients’age and previous endoscopic sphincterotomy were independent risk factors for biliary candidiasis(P<0.05).Patients with immunosuppression(P=0.058)and recent long-term antibiotic therapy(>7 d)(P=0.089)tend to be at risk for biliary candidiasis.One patient was negative in mycological culture of bile fluid but invasive biliary candidiasis was diagnosed histologically.Of Candida subspecies detected,36.7%were azole-resistant,such as C glabrata.Eight patients received anti-mycotic therapy,based on our algorithm.Of these,3 had cancer with biliary tract involvement,2had secondary sclerosing cholangitis,1 had retroperitoneal fibrosis,and 5 had septicemia.In all patients contamination was ruled out by smears of the endoscope channel.CONCLUSION:Gastroenterologists should be aware of frequent candida colonization in patients with cholangitis and biliary disorders.Our suggested algorithm facilitates the further clinical management.