Candida species. Insignificant contaminant or pathogenic species.

Area of Science:

• Medical Mycology
• Infectious Diseases
• Surgical Infections

Background:

• The clinical significance of Candida species in intra-abdominal infections remains unclear.
• Previous studies have not definitively established the role of antifungal therapy in these cases.

Purpose of the Study:

• To evaluate the pathogenicity of Candida species in peritoneal fluid and intra-abdominal abscesses.
• To assess the efficacy and necessity of Amphotericin B treatment in such infections.

Main Methods:

• Retrospective review of Candida cultures from peritoneal fluid and intra-abdominal abscesses at NCMH (1978-1983).
• Analysis of patient demographics, co-infections, treatment regimens (surgical drainage, antibiotics, Amphotericin B), and outcomes (abscess development, mortality).

Main Results:

• Candida in peritoneal fluid (39 patients) did not necessitate Amphotericin B; only one patient developed an abscess, treated successfully with drainage.
• In intra-abdominal abscesses (24 patients), 87.5% had polymicrobial infections. Treatment with drainage and antibiotics alone resulted in a 30% mortality rate, with only one death attributed to Candida.
• Adding Amphotericin B to drainage and antibiotics in polymicrobial abscesses (4 patients) showed a 50% mortality rate, with one death linked to Candida.

Conclusions:

• Amphotericin B treatment for Candida in peritoneal fluid is unnecessary and potentially harmful due to renal toxicity.
• For polymicrobial intra-abdominal abscesses involving Candida, surgical drainage and antibacterial antibiotics are the recommended primary treatments.
• The benefit of adding Amphotericin B to standard treatment for polymicrobial intra-abdominal abscesses containing Candida was not demonstrated and its role remains uncertain.