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Yeast colonization in surgical patients with intra-abdominal perforations
1Department of Bacteriology, National Institute of Public Health, Oslo, Norway. per.sandven@folkehelsa.no
Abstract:
A prospective study was conducted to determine (i) the degree of yeast colonization in surgical patients with intra-abdominal perforations and (ii) whether the frequency of colonization is different in patients with a complicated postoperative course than in patients recovering uneventfully. A total of 1,496 specimens taken per- and post-operatively from the mouth, stomach, feces, urine, trachea, and abdomen of 109 surgical patients with intra-abdominal perforations were examined. Yeast was recovered from 98 (90%) of the patients and from 634 (42%) of the specimens. Approximately 70% of the specimens from the mouth and stomach, 47% of fecal specimens, and 31% of abdominal specimens were positive for yeast. A total of 42 patients had a complicated postoperative course. The majority of these patients were colonized with yeast at multiple body sites: yeast was recovered on one or more occasions from two or more body sites in 90% and from three or more body sites in 71%. Many of the patients with an uncomplicated postoperative course also were colonized: yeast was recovered from two or more body sites in 69% and from three or more body sites in 34%. The results of this study indicate that treatment recommendations based on yeast colonization will expose a large number of patients to unnecessary or even harmful antifungal treatment. This does not mean that yeast colonization is insignificant; however, more accurate criteria and methods based on prospective clinical studies are needed to detect patients at risk of developing severe Candida infection.
Insights
Yeast colonization is common in surgical patients with intra-abdominal perforations, affecting 90% of individuals. However, routine antifungal treatment based solely on colonization may be unnecessary for many patients.
Area of Science:
- Medical Microbiology
- Surgical Infections
Background:
- Yeast colonization is a concern in surgical patients.
- Intra-abdominal perforations present a risk for infection.
Purpose of the Study:
- To assess the extent of yeast colonization in surgical patients with intra-abdominal perforations.
- To determine if colonization frequency differs between complicated and uncomplicated postoperative courses.
Main Methods:
- Prospective study of 109 surgical patients with intra-abdominal perforations.
- Analysis of 1,496 specimens from multiple body sites (mouth, stomach, feces, urine, trachea, abdomen).
- Yeast detection via per- and post-operative specimen examination.
Main Results:
- Yeast was recovered from 90% of patients and 42% of specimens.
- High colonization rates observed in mouth (70%), stomach (70%), feces (47%), and abdomen (31%).
- Patients with complicated postoperative courses showed higher rates of multi-site yeast colonization.
Conclusions:
- Widespread yeast colonization in these patients suggests current treatment guidelines may lead to overuse of antifungals.
- More precise criteria are needed to identify patients genuinely at risk for severe Candida infections.
- Further prospective studies are essential for refining diagnostic and treatment strategies.