Objective To explore the fungal species distribution features in pancreatic infections in patients with acute biliary pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) and analyze the predisposing factors.

Methods A total of 31 patients with pancreatic fungal infection after ERCP for acute biliary pancreatitis admitted to the First Affiliated Hospital of Air Force Medical University of Chinese People's Liberation Army were selected as infection group, and another 155 patients without infection after ERCP for acute biliary pancreatitis during the same period were selected as non-infection group. Clinical data of patients in both groups were collected. A multivariate Logistic regression model was used to analyze the influencing factors of pancreatic fungal infection after ERCP for acute biliary pancreatitis patients. The generalized estimating equation (GEE) model was used to validate the results of the multivariate Logistic regression analysis. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value. The chi-square automatic interaction detector (CHAID) algorithm was applied to construct a decision tree model based on the influencing factors, and a risk score table for pancreatic fungal infection was established. Risk stratification (low-risk and high-risk groups) was performed according to the cut-off value, and the incidence of pancreatic fungal infection after ERCP was compared.

Results In the infection group, the time from admission to the diagnosis of pancreatic infection was 11 (8, 14) days. A total of 38 fungal strains were isolated, with Candida albicans being the most frequently detected strain. Among the 186 patients, one pancreatic juice specimen and one bile specimen were collected for culture after the operation. The time from the diagnosis of pancreatic infection to a positive pancreatic juice specimen culture was 5 (3, 6) days, and the time from the diagnosis of pancreatic infection to a positive bile specimen culture was 6 (4, 7) days. The proportions of positive cultures in pancreatic juice and bile specimens in the infection group were higher than those in the non-infection group, with statistically significant differences (P < 0.05). A high proportion of positive pancreatic juice specimen cultures (OR=10.413, 95%CI, 2.059 to 52.667), a high proportion of positive bile specimen cultures (OR=7.468, 95%CI, 1.603 to 34.789), diabetes (OR=4.567, 95%CI, 1.090 to 19.131), prolonged operation time (OR=1.052, 95%CI, 1.012 to 1.093), inadequate postoperative bile drainage (OR=4.951, 95%CI, 1.304 to 18.802), and high preoperative total bilirubin (TBil) (OR=1.221, 95%CI, 1.100 to 1.354) were independent influencing factors for pancreatic fungal infection after ERCP for acute biliary pancreatitis patients (P < 0.05). High preoperative albumin (OR=0.860, 95%CI, 0.773 to 0.958) was an independent protective factor for pancreatic fungal infection after ERCP for acute biliary pancreatitis patients (P < 0.05). The ROC curve showed that the diagnostic efficacy, sensitivity, and specificity of combined detection were higher than those of single detection. The decision tree model selected three risk factors (results of pancreatic juice and bile specimens and inadequate postoperative bile drainage) as the nodes of the model. Among them, the culture result of the pancreatic juice specimen was the most important predictive factor, and the classification accuracy rate of the model was 83.3%. The incidence of pancreatic fungal infection in high-risk patients was higher than that in low-risk patients, with a statistically significant difference (P < 0.05).

Conclusion Candida albicans is the main fungus detected in pancreatic infections after ERCP for acute biliary pancreatitis. A high proportion of positive pancreatic juice specimen cultures, a high proportion of positive bile specimen cultures, diabetes, prolonged operation time, inadequate postoperative bile drainage, and high preoperative TBil are independent risk factors for pancreatic fungal infection after ERCP for acute biliary pancreatitis patients, while high preoperative albumin is an independent protective factor.