Fungal Sepsis in Surgical Patients

Burchard, Kenneth W.; Minor, Lloyd B.; Slotman, Gus J.; Gann, Donald S.

doi:10.1001/archsurg.1983.01390020065011

Cited by 87 publications

(30 citation statements)

References 8 publications

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“…The mortality rate in this series is lower than that reported in studies of other patient populations with candidemia (e.g., 38% among surgical patients [10] and 70% among immunosuppressed patients [11]). Lower mortality may be related to the transient duration of candidemia and the low colony counts.…”

Section: Discussioncontrasting

confidence: 69%

Candidemia from a Urinary Tract Source: Microbiological Aspects and Clinical Significance

Ang

Telenti

King

et al. 1993

Clinical Infectious Diseases

124

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Twenty-six cases of candidemia associated with a well-defined urinary tract source were retrospectively identified and reviewed. Urinary tract abnormalities were present in 23 of 26 patients (88%), 19 (73%) of whom had urinary tract obstruction. Nineteen patients had undergone urinary tract procedures before the onset of candidemia. Episodes of candidemia were brief and low-grade in intensity (median duration, 1 day; median colony count, 1.5 cfu/10 mL of blood).Only eight patients (31%) received >500 mg of amphotericin B. There were five in-hospital deaths (19%); two of these deaths were attributed to candidiasis. No late complications of candidemia were documented for the surviving patients. Patients with urologic pathology and candiduria who undergo surgery or manipulation of the urinary tract are at significant risk for candidemia, and further studies should examine the issue of administration of prophylaxis to this group.Candiduria often presents a dilemma to the clinician, as it may represent colonization or infection. The prevalence of candiduria has been estimated at 0.2%-6% [1, 2] among asymptomatic volunteers and at 6.5%-20% among hospitalized patients [2,3]. Despite the high prevalence of candiduria, it is not well known which patients will develop complications such as candidemia. For patients in the critical care setting, the mortality associated with urine cultures positive for Candida species was 50%, as opposed to 19% for such patients without cultures positive for Candida [4]. On the other hand, Schonebeck and Ansehn [5] observed 40 patients with candiduria that persisted from 1 to 12 months and found that the infection spontaneously resolved in the majority of patients, although five remained candiduric after >12 months. The goal of this retrospective study was to describe the characteristics of candidemia arising in patients with a well-defined urinary tract source of infection. Materials and MethodsAll patients with blood cultures positive for Candida species at the Mayo Clinic from March 1985 to December 1987 were identified through a review of microbiological records. Patients with candidemia were eligible for inclusion in the study if they had concomitant candiduria and no alternative source of candidemia. Candiduria was defined as the pres- ence of Candida species in urine cultures or the presence of yeast in the urine on microscopy. Recovery of Candida species from skin, sputum, or mucous membranes did not constitute criteria for exclusion. All in-patient and out-patient records were reviewed, and the following data were recorded: age, sex, underlying diseases, potential risk factors, clinical and laboratory features, radiological study findings, pathology reports, and treatment and outcome. Blood cultures were done for patients if they had fever or if the clinical circumstances suggested the possibility of systemic infection.The onset of fungemia was defined as the first day on which blood cultures positive for Candida were obtained. Potential risk factors were defined as: (1) administra...

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Section: Discussioncontrasting

confidence: 69%

Candidemia from a Urinary Tract Source: Microbiological Aspects and Clinical Significance

Ang

Telenti

King

et al. 1993

Clinical Infectious Diseases

124

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“…The CDC has reported an increase in fungal infections from 2.5=1,000 to 5.6=1,000 ICU discharges [50]. The morbidity and mortality rate associated with these infections is striking, with the median ICU stay being increased by as much as 30 days and mortality rates of 30-80% [51][52][53]. The latest National Healthcare Safety Network Report from the CDC, which summarized surveillance data for 2006 from 14 burn units [54], found that burn ICUs had the highest rate of central-line-associated blood stream infections.…”

Section: Fungal Infectionsmentioning

confidence: 99%

Emerging Infections in Burns

Branski

Al-Mousawi

Rivero

et al. 2009

Surgical Infections

290

174

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Background: Patients who suffer severe burns are at higher risk for local and systemic infections. In recent years, emerging resistant pathogens have forced burn care providers world wide to search for alternative forms of treatment. Multidrug-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter spp., and various fungal strains have been the major contributors to the increase in morbidity and mortality rates. Multi-drugresistant S. aureus remains the major cause of gram-positive burn wound infections world wide. Treatment strategies include rigorous isolation protocols and new types of antibiotics where necessary. Methods: We reviewed 398 severely burned patients (burns >40% total body surface area [TBSA]) admitted to our hospital between 2000 and 2006. Patients who did not contract multi-drug-resistant gram-negative organisms during their hospital course and received our standard antibiotic regimen-vancomycin and piperacillin= tazobactam-served as controls (piperacillin=tazobactam; n ¼ 280). The treatment group consisted of patients who, during their acute hospital stay, developed infections with multi-drug-resistant gram-negative pathogens and were treated with vancomycin and colistin for at least three days (colistin; n ¼ 118). Results: Gram-negative organisms continue to cause the most severe infections in burn patients. Colistin has reemerged as a highly effective antibiotic against multiresistant Pseudomonas and Acinetobacter infections of burns. Patients who required colistin therapy had a significantly larger average total and full-thickness burn than patients treated with piperacillin=tazobactam and vancomycin, and the mortality rate was significantly higher in the colistin group (p < 0.05). However, there was no significant difference between the colistin and piperacillin= tazobactam groups in the incidence of neurotoxicity, hepatic toxicity, or nephrotoxicity. The main fungal pathogens in burn patients are Candida spp., Aspergillus spp., and Fusarium spp. A definitive diagnosis is more difficult to obtain than in bacterial infections. Amphotericin B and voriconazole remain the two most important anti-fungal substances in our practice. Conclusions: Innovations in fluid management, ventilatory support, surgical care, and antimicrobial therapy have contributed to a significant reduction in morbidity and mortality rates in burn patients. Vancomycin and clindamycin are the two most important reserve antibiotics for methicillin-resistant Staphylococcus aureus infection. Oxazolidinones and streptogramins have showed high effectiveness against gram-positive infections. Colistin has re-emerged as a highly effective antibiotic against multiresistant Pseudomonas and Acinetobacter infections. Current challenges include Candida, Aspergillus, and molds. The development of new agents, prudent and appropriate use of antibiotics, and better infection control protocols are paramount in the ongoing battle against multi-resistant organisms.

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“…Excluding general hygienic principles,wehavebeen unable to providespecificguidelines advising these patients when to have their hair clipped. furthermore,eventhough some reports haveshown that infectionsfrom contaminated mascara can occur, no reports of infection from commonly used beauty preparations such as shampoos, lotions, and creams werefound [4,5). Wereport here, however, that two patients with acute leukemia and profound neutropenia developed scalp infections due to P. aeruginosa, which had been acquired from contact with contaminated, diluted shampoo.…”

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confidence: 73%

“…Lemonjuice wasfound to be the likelyvehicle of Candida infections in these patients [2][3][4][5][6]; Candida spp, grow welland even selectively in lemon juice [2][3][4][5].…”

mentioning

confidence: 91%