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Clinical significance of Candida isolated from peritoneum in surgical patients
T Calandra1, J Bille, R Schneider
1Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Abstract:
Over a 2-year period, all surgical patients from whom Candida was isolated from intra-abdominal specimens were evaluated. All but 1 of the 49 evaluable patients had either a spontaneous perforation (57%) or a surgical opening of the gastrointestinal tract (41%). Candida caused infection in 19 patients (39%), of whom 7 had an intra-abdominal abscess and 12 peritonitis. In the other 30 patients (61%), there were no signs of infection and specific surgical or medical treatment was not required. Candida was more likely to cause infection when isolated in patients having surgery for acute pancreatitis than in those with either gastrointestinal perforations or other surgical conditions. The development of a clinical infection was significantly associated with a high initial or increasing amount of Candida in the semiquantitative culture. Surgery alone failed in 16 of 19 patients (84%), of whom 7 died and 9 recovered after combined antifungal and surgical treatment. The overall mortality and the mortality related to infections were significantly higher in the patients with intraabdominal candidal infections than in those without such infections.
Insights
Candida in abdominal surgery can lead to serious infections, particularly after pancreatitis. Early antifungal treatment combined with surgery improves outcomes and reduces mortality in these critical intra-abdominal candidal infections.
Area of Science:
- Surgical Infectious Diseases
- Medical Mycology
- Critical Care Medicine
Background:
- Intra-abdominal candidal infections pose significant challenges in surgical patients.
- Candida species are increasingly recognized as pathogens in hospital-acquired infections.
Purpose of the Study:
- To evaluate the incidence and outcomes of intra-abdominal candidal infections in surgical patients.
- To identify risk factors associated with Candida causing infection.
- To assess the efficacy of different treatment strategies.
Main Methods:
- Retrospective analysis of 49 surgical patients with intra-abdominal Candida isolates over 2 years.
- Evaluation of patient demographics, underlying conditions, culture results, and treatment outcomes.
- Correlation of Candida load with clinical infection development.
Main Results:
- 39% of patients developed clinical Candida infection (abscess or peritonitis).
- Infection risk was higher in patients undergoing surgery for acute pancreatitis compared to gastrointestinal perforations.
- High or increasing Candida load in cultures significantly correlated with infection development.
- Surgery alone was ineffective in 84% of infected patients; combined antifungal and surgical treatment improved recovery.
- Intra-abdominal candidal infections were associated with significantly higher overall and infection-related mortality.
Conclusions:
- Intra-abdominal candidal infections are associated with high morbidity and mortality in surgical patients.
- Prompt diagnosis and combined antifungal and surgical management are crucial for improving patient outcomes.
- Risk stratification, especially in pancreatitis patients, is important for early intervention.