[Candidiasis in the field of gastroenterological surgery]

Postoperative candidiasis in the gastroenterological surgery has an increasing tendency with poor prognosis particularly in generalized cases. Candida is difficult to be specified as infectious agent only by culture findings, and has a problem on rapidity and sensitivity. Furthermore, also as for the time starting antifungal treatment, the start after the blood culture has given positive result is problematic. We analyzed the present state of candidiasis in our department and studied its background factors. Totaling of 4,424 samples from all of bacterial and fungal culture tests performed at our department for recent 9 years revealed detection of Candida with the incidence of 24%. The incidence was about 2.5 times increased in the former half of the period as compared with the later half of the period. The background factors were intravenous hyperalimentation, major operations (long operative time, insertion of many drains), splenectomy, pancreatectomy, intensive chemotherapy, radiation therapy, hyperthermia therapy, aging, continuous use of steroids, etc. Then, we determined concentrations of beta-D-glucan, a fungal component, and evaluated the results since it is being applied to early diagnosis of candidiasis. We performed early antifungal treatment before confirmation of positive culture finding in high risk group of candidiasis and obtained effective results.