Gallbladder and biliary tract candidiasis.
BACKGROUND
The clinical significance of Candida spp isolated from the gallbladder on the biliary tract is relatively unknown.


METHODS
To provide this information, patients with Candida spp isolated from gallbladder and other biliary tract sources during a 10-year period were identified through the records of our clinical microbiology laboratory. Medical records were analyzed for biliary disease causes, culture data, treatment, and outcome.


RESULTS
Twenty-seven patients were identified. Five of seven patients with cholecystitis were critically ill intensive care unit (ICU) patients in whom the mortality rate was 100%. Gallstone pancreatitis was found in four patients and was fatal in one patient with a pancreatic abscess and ongoing retroperitoneal sepsis. An external biliary shunt/endoprosthesis was placed in 16 patients to relieve biliary obstruction. Cholangitis was present in 14 patients, and most bile cultures contained Candida as part of a mixed flora. Only 3 of 27 patients had candidemia, and 22 of 27 patients were colonized with Candida at other sites.


CONCLUSIONS
(1) The ICU patient with Candida cholecystitis has a grave prognosis. (2) Patients with Candida isolated from biliary stents placed for obstruction and cholangitis should be treated with both antifungal and broad spectrum antimicrobial agents. (3) Candidemia is not frequently seen in this setting.
Diebel
L N
LN
Department of Surgery, Wayne State University, Detroit, Mich., USA.
Raafat
A M
AM
Dulchavsky
S A
SA
Brown
W J
WJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001659:Biliary Tract / Q000382:microbiology*; D002177:Candidiasis / Q000175:diagnosis*; D002761:Cholangitis / Q000382:microbiology; D002764:Cholecystitis / Q000382:microbiology; D005260:Female; D005704:Gallbladder / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000382:microbiology; D012189:Retrospective Studies