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

Table 1 Baseline characteristics of the study population (n = 127)

	No biliary candidiasis (n = 89)	Biliary candidiasis (n = 38)	P value
Age (mean ± SD), yr	58.3 ± 15.6	64.7 ± 15.0	< 0.05
Male/female	52/37	20/18	NS
Primary diagnosis			NS
Suspected carcinoma of the biliary tract	16 (18.0)	10 (26.3)
Stenosing papillitis	11 (12.4)	3 (7.9)
Carcinoma	9 (10.1)	6 (15.8)
PSC	9 (10.1)	5 (13.2)
CBD stenosis of unknown origin	13 (14.6)	5 (13.2)
Choledocholithiasis	9 (10.1)	3 (7.9)
Cholestatic hepatitis	4 (4.5)	1 (2.6)
Pancreatitis	4 (4.5)	-
Other	14 (15.7)	5 (13.2)
Indication for ERCP			NS
CBD stenosis	18 (20.2)	10 (26.3)
Suspected carcinoma	15 (16.9)	8 (21.1)
Carcinoma	9 (10.1)	6 (15.8)
Cholestasis	9 (10.1)	3 (7.9)
Choledocholithiasis	8 (9.0)	1 (2.6)
Cholangitis	7 (7.9)	2 (5.3)
PSC	6 (6.7)	5 (13.2)
Papillitis stenosans	4 (4.5)	-
Pancreatitis	2 (2.2)	-
Cholestatic hepatitis	1 (1.1)	1 (2.6)
Other	10 (11.2)	2 (5.3)

ERCP: Endoscopic retrograde cholangiopancreatography; CBD: Common bile duct; NS: Not significant; PSC: Primary sclerosing cholangitis; Other: Ischemic type biliary lesions, stenosis of the biliary anastomosis after liver transplantation, biliary cast syndrome, retroperitoneal fibrosis, iatrogenic injury of the bile duct, suspected primary or secondary sclerosing cholangitis.

Table 2 Laboratory results at the time of intervention (n = 127)

	CRP	Hemoglobin	Leukocytes	Thrombocytes	Bilirubin	Creatinine	GGT	AP	AST	ALT	PCHE	Lipase
	(mg/dL)	(g/dL)	(1000/μL)	(1000/μL)	(mg/dL)	(mg/dL)	(U/L)	(U/L)	(U/L)	(U/L)	(U/L)	(U/L)
Group I
mean ± SD	3.9 ± 6.1	12.2 ± 1.8	7.9 ± 4.5	258.5 ± 151.5	4.0 ± 7.2	1.1 ± 0.7	507.6 ± 766.7	374.4 ± 301.4	120.0 ± 134.6	124.0 ± 182	2161.5 ± 3580.3	196.2 ± 568.1
Group II
mean ± SD	3.9 ± 3.3	11.6 ± 2.0	7.6 ± 3.7	270.6 ± 144.0	5.1 ± 7.7	1.2 ± 1.0	430.1 ± 403.4	395.8 ± 281.6	106.8 ± 90.8	101.1 ± 110.8	576.4 ± 1144.5	226.5 ± 623.6
P	0.090	0.090	0.900	0.525	0.341	0.767	0.424	0.722	0.940	0.870	0.501	0.790

P data generated by Mann-Whitney U test. Group I: Patients without biliary candidiasis, n = 89; Group II: Patients with biliary candidiasis, n = 38. CRP: C-reactive protein; PCHE: Pseudocholinesterase; GGT: Gamma glutamyl transpeptidase; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; AP: Alkaline phosphatase.

Table 3 Risk factors for biliary candidiasis n (%)

Risk factors	No biliary candidiasis (n = 89)	Biliary candidiasis (n = 38)	P value	Exp(B)	95%CI for exp(B)
Age	58.3 ± 15.6	64.7 ± 15.0	0.036	1.034	1.002-1.067
Malignancy	20 (22.5)	15 (39.5)	0.242	0.494	0.152-1.609
Cholangio-carcinoma	8 (9.0)	7 (18.4)	0.372	0.497	0.107-2.310
Immunosup-pression	42 (47.2)	26 (68.4)	0.058	0.403	0.158-1.031
ICU	2 (2.2)	2 (5.3)	1.000
Mechanical ventilation	2 (2.2)	1 (2.6)	1.000	2.3E+9
Antibiotic therapy	42 (47.2)	26 (68.4)	0.200	0.530	0.201-1.399
Long-term antibiotic therapy (> 7 d)	9 (10.1)	11 (28.9)	0.089	0.354	0.107-1.170
Previous EST	51 (57.3)	25 (65.8)	0.012	0.246	0.082-0.739
Previous ERCP	53 (59.6)	26 (68.4)	0.574	1.318	0.504-3.444

ERCP: Endoscopic retrograde cholangiopancreatography; EST: Endoscopic sphincterotomy; ICU: Intensive care unit.

Table 4 Distribution of fungal species in bile samples, buccal smears and stool samples n (%)

	No biliary candidiasis (n = 89)	Biliary candidiasis (n = 38)	P value
Bile samples
Positive	89/127 (70.1)	38/127 (29.9)
Candida albicans (C. albicans)		23 (60.5)
Candida tropicalis (C. tropicalis)		4 (10.5)
Candida dubliniensis (C. dubliniensis)		1 (2.6)
Candida glabrata (C. glabrata)		6 (15.8)
Candida krusei		1 (2.6)
C. albicans et glabrata		2 (5.3)
C. albicans et tropicalis		1 (2.6)
Buccal smears
Positive	42/89 (47.2)	28/38 (73.7)	0.007
C. albicans	30 (71.4)	17 (60.7)
C. tropicalis	1 (2.4)	1 (3.6)
C. dubliniensis	2 (4.8)	1 (3.6)
C. glabrata	3 (7.2)	2 (7.2)
Mixed cultures	6 (14.3)	7 (25.0)
Stool samples
Positive	24/62 (38.7)	14/27 (51.9)	0.489
C. albicans	14 (58.3)	4 (28.6)
C. tropicalis	1 (4.2)	1 (7.2)
C. dubliniensis	1 (4.2)	1 (7.2)
C. glabrata	2 (8.3)	4 (28.6)
Other	3 (12.5)	-