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Indications for therapy for fungemia in postoperative patients
Abstract:
We reviewed the clinical courses of 63 surgical patients who had experienced one or more days of fungemia, to determine the clinical setting for such infections and to define indications for systemic therapy. Fifty-one patients experienced fungemia as a late complication of intraperitoneal infection. Candida was identified as part of a polymicrobial flora in 70%. If untreated, the mortality was 83% (30 of 36). No untreated patients with fungemia for more than one day survived. Adequate therapy with amphotericin B (total dose, greater than 3 mg/kg) improved survival to 67% (ten of 15). Autopsies performed in 20 cases revealed visceral Candida microabscesses in seven, with the gastrointestinal tract (12) and intraabdominal abscess (five) as the most common sources of fungi. These data support the concept of Candida as an important participant in polymicrobial infection and recommend therapy with amphotericin B for patients with intraperitoneal infection experiencing fungemia.
Insights
Fungal infections (fungemia) in surgical patients, often linked to abdominal issues, are deadly if untreated. Early amphotericin B therapy significantly improves survival rates for these serious Candida infections.
Area of Science:
- Infectious Diseases
- Surgical Infections
- Mycology
Background:
- Fungemia is a serious complication in surgical patients, particularly those with intra-abdominal infections.
- Candida species are frequently involved in polymicrobial infections within the abdominal cavity.
Purpose of the Study:
- To determine the clinical settings of fungemia in surgical patients.
- To define indications for systemic antifungal therapy.
- To evaluate the impact of therapy on mortality.
Main Methods:
- Retrospective review of clinical courses of 63 surgical patients with fungemia.
- Analysis of infection sources, causative organisms, and treatment outcomes.
- Autopsy findings in 20 cases to identify visceral microabscesses and fungal sources.
Main Results:
- Fifty-one patients (81%) developed fungemia as a late complication of intraperitoneal infection.
- Candida was part of polymicrobial flora in 70% of cases.
- Untreated fungemia had an 83% mortality rate; no untreated patients survived fungemia >1 day.
- Amphotericin B therapy ( >3 mg/kg) improved survival to 67% (10/15).
- Autopsies revealed visceral Candida microabscesses in 7/20 patients, with GI tract and intra-abdominal abscesses as common sources.
Conclusions:
- Candida plays a significant role in polymicrobial intra-abdominal infections.
- Systemic therapy with amphotericin B is recommended for surgical patients with intraperitoneal infections experiencing fungemia.
- Prompt diagnosis and treatment are crucial for improving outcomes in fungemia.