Outcomes Following Antifungal Treatment for Candida Growth in Bile Cultures Collected During Endoscopic Retrograde Cholangiopancreatography

TL;DR

This study found that antifungal treatment for Candida in bile cultures during ERCP did not improve patient outcomes, suggesting a conservative approach is better.

Contribution

The study provides new evidence that antifungal treatment for Candida in bile cultures does not improve clinical outcomes in patients.

Findings

Antifungal treatment was not associated with improved survival or lower rates of invasive candidiasis.

No significant differences were observed in outcomes for patients with acute cholangitis.

The findings support a conservative approach to managing Candida-positive bile cultures.

Abstract

Candida species are frequently detected in bile cultures during endoscopic retrograde cholangiopancreatography (ERCP), but their clinical significance and the value of antifungal treatment remain unclear. We performed a retrospective single-center cohort study of adults with growth of Candida species from bile cultures collected by ERCP performed between 2010 and 2023. We compared inpatients who received vs. those who did not receive antifungals within one week of ERCP and a subgroup with acute cholangitis. The primary outcome was a composite of death and invasive candidiasis within one year. Secondary outcomes included death, invasive candidiasis, and rehospitalization. Inverse probability of treatment weighting (IPTW) was performed using baseline characteristics. Adjusted hazard ratios and odds ratios were calculated. Among 197 inpatients, 51 (25.9%) received antifungals. At one year, the primary outcome occurred in 23 of 51 patients (45.1%) receiving antifungal therapy and in 67 of 146 patients (45.9%) who did not; the IPTW-adjusted hazard ratio was 0.93 (95% confidence interval 0.69–1.27; p = 0.66). No significant differences were seen in the acute cholangitis subgroup (n = 117). In this study, antifungal therapy was not associated with improved survival, lower rates of invasive candidiasis, or fewer readmissions. Findings support a conservative, stewardship-oriented approach to managing Candida-positive bile cultures in the absence of invasive disease.

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