Related Experiment Videos
Candida species. Insignificant contaminant or pathogenic species
Abstract:
The pathogenicity of Candida species cultured from peritoneal fluid or from an intra-abdominal abscess is unknown. A review of cultures at NCMH from 1978 to 1983 showed that Candida species were cultured from the peritoneal fluid of 39 patients and from intra-abdominal abscesses in 24 patients. The average age was 49 (range 6 months to 102 years); there were 38 men and 25 women. None of the 39 patients with Candida species grown from the peritoneal fluid was treated with Amphotericin B and only 1 (2.6%) subsequently developed an abscess. This patient was treated by surgical drainage without Amphotericin B and recovered. Twenty-four patients had Candida cultured from an intra-abdominal abscess. Of these, 21 (87.5%) also grew other bacterial organisms. Twenty of these 24 patients were treated with surgical drainage and antibacterial antibiotics without Amphotericin B. Six (30%) died, but only one death was felt to be directly related to the Candida infection. The remaining four were treated with surgical drainage, appropriate antibacterial antibiotics, and Amphotericin B. Two of these four (50%) died; one of the two deaths was related to Candida infection. Candida species grown from the peritoneum were not related to later Candida infection. Treatment of patients with contamination of the peritoneum by Candida with Amphotericin B appears unnecessary and because of Amphotericin renal toxicity, may be potentially harmful. Patients with polymicrobial intra-abdominal abscesses that contain Candida species should be treated with surgical drainage and appropriate antibacterial antibiotics. The value of adding Amphotericin B therapy in patients with polymicrobial abscess containing Candida was not demonstrated in this study, and its role is unclear.
Insights
Candida in peritoneal fluid rarely leads to abscesses and does not require Amphotericin B treatment. For intra-abdominal abscesses with Candida, surgical drainage and antibiotics are key; Amphotericin B
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.