Related Experiment Video
Updated: Oct 10, 2025
Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
Vascular Graft Infections With Candida: A Factor for Increased Mortality in in-situ Reconstructions
Dries Dorpmans1, Karen Peeters1, Hozan Mufty1
1Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium.
Background:
The empiric antibiotic regimen started after deep cultures and explantation of the graft mostly do not cover antifungals. We retrospectively studied the outcome of candida compared to non-candida VGI and assessed whether these results could justify the addition of antifungals to the empiric antibiotics in the early postoperative period.
Methods:
All patients treated for infected aorto(ilio)femoral graft with excision and reconstruction at the vascular department of University Hospitals Leuven between January 2010 and 2017 (n = 56) were studied retrospectively. Patients were allocated to the candida group (n = 10) or non-candida group (n = 46) according to the presence of Candida in deep culture isolates.
Results:
All-cause mortality was significantly higher in the candida group compared to the non-candida group. All-cause 30-day mortality was 40% and 13% for both groups respectively (P = 0.066). At 5 years this was 90% and 46% respectively (P = 0.014). In the candida group 6 patients (60%) had to be revised in the operating room due to bleeding, compared to 5 patients (11%) in the non-candida group (P = 0.002). Two patients (20%) and 5 patients (11%) had to be readmitted to the ICU, respectively.
Conclusion:
Survival of candida related VGI is significantly worse, especially in the first 5 postoperative months. This could justify the addition of an antifungal to the early empiric postoperative antibiotic cocktail, especially in patients with an aorto-enteric fistula. A cost-benefit analysis could be useful to evaluate the yield.
Insights
Candida infections in vascular graft infections (VGI) significantly increase mortality and reoperation rates. Early antifungal use in empiric antibiotic regimens may improve outcomes for these critical infections.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Critical Care Medicine
Background:
- Empiric antibiotic regimens for vascular graft infections (VGI) often lack antifungal coverage.
- Candida species are a potential cause of VGI with significant clinical implications.
Purpose of the Study:
- To compare outcomes of Candida VGI versus non-Candida VGI.
- To assess if adding antifungals to empiric antibiotics is warranted.
Main Methods:
- Retrospective study of 56 patients with infected aorto(ilio)femoral grafts undergoing excision and reconstruction.
- Patients categorized into Candida (n=10) and non-Candida (n=46) groups based on deep culture isolates.
Main Results:
- Higher all-cause mortality in the Candida group (90% at 5 years) compared to the non-Candida group (46%).
- Significantly higher reoperation rates due to bleeding in the Candida group (60% vs. 11%).
- Increased ICU readmission rates observed in the Candida group.
Conclusions:
- Candida-related VGI is associated with significantly worse survival, particularly within the first five postoperative months.
- Addition of antifungals to early empiric antibiotic therapy may be justified, especially in cases of aorto-enteric fistula.
- Further cost-benefit analysis is recommended to evaluate the utility of early antifungal administration.
Related Concept Videos
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:25Hemodialysis I: Introduction