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Outcome and management of invasive candidiasis following oesophageal perforation

Martin Hoffmann1, Peter Kujath, Florian-M Vogt

  • 1Surgery/Thoracic Surgery, University Clinic of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany. drmartinhoffmann@googlemail.com

Mycoses
|August 29, 2012
PubMed

Insights

Oesophageal perforation can lead to Candida contamination in the mediastinum and pleura. Rising fluconazole resistance in non-albicans Candida species necessitates targeted antifungal therapy, often starting with echinocandins.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Gastroenterology

Background:

  • Oesophageal perforation poses a risk for mediastinal and pleural contamination by Candida species.
  • Candida colonization is a known complication following oesophageal perforation.

Purpose of the Study:

  • To analyze the incidence and outcomes of Candida infections in patients with oesophageal perforation.
  • To identify trends in Candida species and their antifungal susceptibility.
  • To provide recommendations for antifungal therapy in this patient population.

Main Methods:

  • Retrospective analysis of 80 patients with oesophageal perforation (1986-2010).
  • Identification of Candida species from various clinical samples, including mediastinal biopsies and broncho-alveolar secretions.
  • Comparison of mortality rates between Candida-positive and Candida-negative patient groups.

Main Results:

  • Candida species were detected in 30% of patients.
  • Mortality was higher in Candida-positive patients (41%) compared to Candida-negative patients (23%), though not statistically significant (P=0.124).
  • Septic complications like mediastinitis and pneumonia were primary causes of mortality.
  • A shift towards non-albicans Candida species with reduced fluconazole susceptibility was observed.

Conclusions:

  • Candida infections following oesophageal perforation are associated with increased mortality.
  • Emerging resistance to fluconazole in non-albicans species requires careful consideration in treatment strategies.
  • Antimycotic therapy, initiated with echinocandins, is recommended for high-risk patients with risk factors such as immunosuppression or granulocytopenia.

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