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Systemic candidiasis in cardiac surgery patients
A Michalopoulos1, J Kriaras, S Geroulanos
1Cardiothoracic ICU, Onassis Cardiac Surgery Center, Athens, Greece.
Summary
Systemic candidiasis frequently affects cardiac surgery patients with prolonged intensive care unit (ICU) stays, increasing costs and mortality. Fluconazole effectively treats this severe fungal infection.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Systemic candidiasis poses a significant risk to patients undergoing cardiac surgery.
- Prolonged intensive care unit (ICU) stays are associated with increased susceptibility to infections.
Purpose of the Study:
- To determine the incidence, risk factors, and outcomes of systemic candidiasis in cardiac surgery patients.
- To evaluate the effectiveness of fluconazole in treating disseminated fungal infections in this population.
Main Methods:
- A cohort of 2615 adult cardiac surgery patients was studied.
- Patients were stratified based on ICU length of stay, with a 9-day cutoff.
- Predisposing factors, clinical course, and treatment outcomes were analyzed.
Main Results:
- Systemic candidiasis occurred in 20.3% of patients with prolonged ICU stays (over 9 days).
- Risk factors included advanced age, diabetes, central venous catheters, prolonged ventilation, and extended ICU/hospitalization.
- Mortality was 27.2%, but fluconazole treatment led to clinical improvement and negative cultures.
Conclusions:
- A prolonged ICU stay (>9 days) is a significant risk factor for systemic candidiasis in cardiac surgery patients.
- This infection substantially increases ICU and hospital length of stay and associated costs.
- Fluconazole is an effective and well-tolerated treatment for severe systemic candidiasis, offering an alternative to amphotericin B.