AIM: To develop an algorithm to improve the diagnosis and treatment of patients with biliary candidiasis. METHODS: We performed a prospective study of 127 patients who underwent endoscopic retrograde cholangiopancreatography, for various biliary disorders, at 3 tertiary referral centers in Germany from July 2011 through 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, 2 had 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.
AIM: To develop an algorithm to improve the diagnosis and treatment of patients with biliary candidiasis. METHODS: We performed a prospective study of 127 patients who underwent endoscopic retrograde cholangiopancreatography, for various biliary disorders, at 3 tertiary referral centers in Germany from July 2011 through 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, 2 had 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.
Authors: M Ruhnke; A Böhme; D Buchheidt; O Cornely; K Donhuijsen; H Einsele; R Enzensberger; H Hebart; C P Heussel; M Horger; H Hof; M Karthaus; W Krüger; G Maschmeyer; O Penack; J Ritter; S Schwartz Journal: Ann Oncol Date: 2011-09-23 Impact factor: 32.976
Authors: Marek Pacholczyk; Beata Lagiewska; Wojciech Lisik; Dariusz Wasiak; Andrzej Chmura Journal: Ann Transplant Date: 2011 Jul-Sep Impact factor: 1.530
Authors: B J Kullberg; P E Verweij; M Akova; M C Arendrup; J Bille; T Calandra; M Cuenca-Estrella; R Herbrecht; F Jacobs; M Kalin; C C Kibbler; O Lortholary; P Martino; J F Meis; P Muñoz; F C Odds; B E De Pauw; J H Rex; E Roilides; T R Rogers; M Ruhnke; A J Ullmann; Ö Uzun; K Vandewoude; J-L Vincent; J P Donnelly Journal: Clin Microbiol Infect Date: 2011-09 Impact factor: 8.067
Authors: O A Cornely; M Bassetti; T Calandra; J Garbino; B J Kullberg; O Lortholary; W Meersseman; M Akova; M C Arendrup; S Arikan-Akdagli; J Bille; E Castagnola; M Cuenca-Estrella; J P Donnelly; A H Groll; R Herbrecht; W W Hope; H E Jensen; C Lass-Flörl; G Petrikkos; M D Richardson; E Roilides; P E Verweij; C Viscoli; A J Ullmann Journal: Clin Microbiol Infect Date: 2012-12 Impact factor: 8.067