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Postoperative candidiasis
1Department of Surgery, University of Turku, Finland.
Abstract:
Candida species are important opportunistic pathogens in compromised hosts, such as patients recovering from major abdominal surgery. The incidence, pathogenesis, diagnosis and prognosis of postoperative candidiasis were studied in a general surgical department. Transplantation surgery was not included. The mean incidence of postoperative candidiasis in abdominal surgery was 6.2 per 1000 laparotomies. The estimated incidence was higher during the years 1987-1992 than 1981-1986. Postoperative candidiasis was most often encountered in patients undergoing surgery of the small intestine or pancreas. These patients had certain typical features: a long hospitalization before signs, central catheterization, parenteral nutrition, prolonged antibiotic therapy and reoperations; malignancy, corticosteroid or immunosuppressive therapy were uncommon. Multiple blood cultures during reoperations were not found to yield Candida; hence, hematogenous dissemination from the gut was not seen. The prognosis of postoperative candidiasis was poor: the infection mortality was 70-79% and significantly higher than in patients with postoperative bacterial septicemia. Early therapeutic measures resulted in a significantly better prognosis as compared to delayed treatment. Arabinitol was found a specific marker of candidiasis, but because sequential samples were needed for adequate sensitivity, a single arabinitol concentration determination in the beginning of the disease was not useful. Febrile patients who had Candida in any sample during the first postoperative week had a poor prognosis. The results show that patients with candidiasis have typical clinical features that facilitate suspicion. Antifungal therapy is mandatory and must be started as soon as a suspicion of candidiasis has risen, before the results of specific laboratory tests are available.
Insights
Postoperative candidiasis in abdominal surgery patients has a high mortality rate. Early antifungal therapy is crucial for improving outcomes, as diagnosis often relies on clinical suspicion before lab results are available.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Surgical Infections
Background:
- Candida species are opportunistic pathogens in immunocompromised individuals.
- Postoperative candidiasis poses a significant risk to patients undergoing major abdominal surgery.
Purpose of the Study:
- To investigate the incidence, pathogenesis, diagnosis, and prognosis of postoperative candidiasis in abdominal surgery.
- To identify risk factors and clinical features associated with candidiasis in surgical patients.
Main Methods:
- Retrospective study of postoperative candidiasis in a general surgical department (excluding transplantation).
- Analysis of incidence rates, patient demographics, clinical features, and treatment outcomes.
- Evaluation of diagnostic markers like arabinitol and the impact of treatment timing.
Main Results:
- The incidence of postoperative candidiasis was 6.2 per 1000 laparotomies, with higher rates in 1987-1992.
- Small intestine and pancreas surgeries were associated with higher candidiasis risk, often linked to prolonged hospitalization, central lines, and antibiotics.
- Mortality for candidiasis was high (70-79%), significantly exceeding bacterial septicemia; early treatment improved prognosis.
Conclusions:
- Postoperative candidiasis in abdominal surgery presents with distinct clinical features aiding early suspicion.
- Prompt initiation of empirical antifungal therapy is essential, even before definitive laboratory confirmation.
- Effective management requires timely diagnosis and intervention to mitigate the poor prognosis associated with this infection.