[Invasive Candida infection in surgical patients: a valid clinical entity]
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Published on: March 22, 2024
G Geldner1, M Ruhnke, P Lepper
1Sektion Operative Intensivmedizin, Abt. Klin. Anästhesiologie, Universitätsklinikum Ulm.
Objective:
Establishment of a case definition for invasive candidosis in postsurgical intensive care patients.
Methods:
During the period of 1996-1999, 8 cases of invasive candidosis were observed on a surgical intensive care unit. Patient records were evaluated with respect to diagnostic criteria and response to antimycotic therapy.
Results:
Patients included 3 women and 5 men with a mean age of 62.7 (37-85) years. Candida peritonitis (n = 6) occurred after surgery or perforation of the intestinal tract, and Candida pneumonia was due to artificial ventilation (n = 3). C. albicans was isolated in all 8 cases, but mixed infections with other Candida spp. occurred in 3 cases. The Candida serum antigen test yielded a positive result in only 2/8 cases. I.v. therapy with fluconazole was successful in 7 cases, one patient with severe initial disease died with ongoing infection. With the exception of the lethal case, all patients showed a diagnostic serum antibody test, proving systemic candida infection.
Conclusion:
Based on the case descriptions, we propose the following definition of invasive candidosis: (1) Clinical signs of infection after surgery, (2) absence of bacterial pathogens and/or failure to respond to systemic antibiotics, (3) cultivation of Candida spp. from normally sterile sites or abundant growth in tracheal aspirate, (4) response to antimycotic therapy and (5) diagnostic serum antibody test. This definition proved to be valid for our patients and could be used as an inclusion criterion for future clinical studies of serodiagnosis of Candida infection or antimycotic chemotherapy.
Insights
A new case definition for invasive candidosis in surgical intensive care patients is proposed. This definition aids in diagnosing Candida infections and guides future clinical studies.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Medical Microbiology
Background:
- Invasive candidosis is a serious complication in postsurgical intensive care unit (ICU) patients.
- Accurate diagnosis is crucial for effective treatment and patient outcomes.
- Existing diagnostic criteria may not be optimal for this specific patient population.
Observation:
- Eight cases of invasive candidosis were identified in a surgical ICU between 1996 and 1999.
- Common presentations included Candida peritonitis and pneumonia.
- Candida albicans was the predominant species, often in mixed infections.
Findings:
- The proposed case definition includes clinical signs, absence of bacterial pathogens, isolation of Candida from sterile sites or tracheal aspirates, response to antimycotic therapy, and a positive serum antibody test.
- Conventional serum antigen tests showed low sensitivity (2/8).
- Antimycotic therapy, primarily fluconazole, was successful in 7 out of 8 patients.
Implications:
- The proposed definition can serve as a valuable inclusion criterion for future clinical studies on invasive candidosis.
- This definition may improve the accuracy of serodiagnosis and evaluation of antimycotic chemotherapy in postsurgical ICU patients.
- Further validation in larger cohorts is warranted.
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