Outcome and management of invasive candidiasis following oesophageal perforation. Issue 2 (24th August 2012)

• Record Type: Journal Article
• Authors: Hoffmann, Martin; Kujath, Peter; Vogt, Florian‐M.; Laubert, Tilman; Limmer, Stefan; Mulrooney, Thomas; Bruch, Hans‐Peter; Jungbluth, Thomas; Schloericke, Erik
• Is Part Of: Mycoses. Volume 56:Issue 2(2013)
• Page Start: 173
• Page End: 178
• Publication Date: 2012-08-24
• Subjects: Pathogenic fungi -- Periodicals; Medical mycology -- Periodicals; 616.969
• DOI: 10.1111/j.1439-0507.2012.02229.x
• Languages: English
• ISSNs: 0933-7407

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Summary</title> <p>The regular colonisation of the oesophagus with a <italic>Candida</italic> species can, after oesophageal perforation, result in a contamination of the mediastinum and the pleura with a <italic>Candida</italic> species. A patient cohort of 80 patients with oesophageal perforation between 1986 and 2010 was analysed retrospectively. The most common sources with positive results for <italic>Candida</italic> were mediastinal biopsies and broncho‐alveolar secretions. <italic>Candida</italic> species were detected in 30% of the patients. The mortality rate was 41% in patients with positive microbiology results for <italic>Candida</italic>, whereas it was 23% in the remaining patient cohort. This difference did not reach statistical significance (<italic>P</italic> = 0.124). Mortality associated with oesophageal perforation was attributed mainly to septic complications, such as mediastinitis and severe pneumonia. During the study period we observed a shift towards non‐albicans species that were less susceptible or resistant to fluconazole. In selected patients with risk factors as immunosuppression, granulocytopenia and long‐term intensive‐care treatment together with the finding of <italic>Candida</italic>, an antimycotic therapy should be started. A surgical approach offers the possibility to obtain deep tissue biopsies. The antimycotic therapy should start with an echinocandin, as the resistance to fluconazole is growing and to cover non‐albicans <italic>Candida</italic> species, too.</p> </abstract>