Getting it right first time in a patient with Candida peritonitis

Area of Science:

• Medicine
• Infectious Diseases
• Surgical Critical Care

Background:

• Robot-assisted thoracolaparoscopic esophagectomy is a complex procedure with potential complications.
• Healthcare-associated invasive fungal infections, particularly Candida, pose significant challenges in critically ill patients.
• The emergence of multidrug-resistant organisms necessitates careful consideration of treatment strategies.

Observation:

• A patient developed mediastinitis, pleural empyema, and peritonitis after a complicated robot-assisted thoracolaparoscopic esophagectomy.
• The infections were caused by a polymicrobial etiology, including Candida glabrata and Enterococcus faecium.
• The patient's critical condition presented therapeutic dilemmas for management.

Findings:

• Treatment of invasive Candida glabrata infections, especially in polymicrobial settings, can be challenging.
• Echinocandin therapy is a common treatment for invasive candidiasis, but resistance or suboptimal response can occur.
• This case highlights the complexities in managing invasive fungal infections in the context of surgical complications.

Implications:

• Physicians must be vigilant for invasive Candida infections in critically ill surgical patients.
• Current guidelines for treating healthcare-associated invasive Candida infections may require adaptation for complex cases.
• Further research into optimal therapeutic approaches for invasive Candida glabrata and polymicrobial infections is warranted.