Secondary mycosis in surgery: treatment with fluconazole

Together with the severity of the underlying disease, mycotic infections are assuming increasing significance in surgical patients under intensive care. 26 patients with severe internal mycotic infections were treated with fluconazole in an open clinical trial. The pathogens isolated were Candida albicans in 22 cases, Candida tropicalis in four, Torulopsis glabrata in three, Candida parapsilosis in two and Aspergillus fumigatus in one. Mixed infections were found in five cases. Most of this series of surgical patients had a severe, life-threatening post-operative condition. Their mean classification by the Apache score was 15.35. The most frequent risk factors were previous injuries to intraabdominal hollow organs and extensive antibiotic therapy; and the peritoneum was, therefore, the commonest site of infection. Antimycotic therapy was with fluconazole at a dose of 200-400 mg daily for at least ten days. The mycosis was cured in 22 of the 26 patients, one of these being a case of severe mycotic peritonitis. Nine patients died of the underlying disease within four weeks of the beginning of treatment. Fluconazole was effective and well tolerated in the treatment of severe life-threatening infections in surgical patients.