Life-threatening <i>Candida</i> Infections in the Intensive Care Unit

Franklin, Cory; Metry, Michael

doi:10.1177/088506669200700302

Cited by 6 publications

(6 citation statements)

References 80 publications

(40 reference statements)

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“…The suppression of the normal bacterial flora in the gastrointestinal tract by broad spectrum antibiotic therapy also allows the yeast to proliferate. This may not produce systemic infection in otherwise healthy patients, but life-threatening illness may result in the critically ill [18,19,5]. Such Candida colonisation is probably a prerequisite for invasive infection; in neutropenic patients with hematologic malignancies, long-term and high density colonisation has been shown to lead to candidemia [20].…”

Section: Pathogenesis Of Invasive Candida Infectionsmentioning

confidence: 99%

“…Incidence ( intestinal bacterial flora allows the proliferation of Candida within the gastrointestinal tract, which is a precondition of systemic infection [5]. The diagnosis of serious Candida infection may be difficult, although the clinical conditions which predispose patients to these infections are becoming better known and effective antifungal therapies are increasingly available.…”

Section: Introductionmentioning

confidence: 99%

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Epidemiology, diagnosis and treatment of systemic Candida infection in surgical patients under intensive care

et al. 1998

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The incidence of systemic Candida infections in patients requiring intensive care has increased substantially in recent years as a result of a combination of factors. More patients with severe underlying disease or immunosuppression from anti-neoplastic or anti-rejection chemotherapy and at risk from fungal infection are now admitted to the ICU. Improvements in supportive medical and surgical care have led to many patients who would previously have died as a result of trauma or disease surviving to receive intensive care. Moreover, some therapeutic interventions used in the ICU, most notably broad-spectrum antibiotics and intravascular catheters, are also associated with increased risks of candidiasis. Systemic Candida infections are associated with a high morbidity and mortality, but remain difficult to diagnose and ICU staff need to be acutely aware of this often insidious pathogen. A number of studies have identified risk factors for systemic Candida infection which may be used to identify those at highest risk. Such patients may be potential candidates for early, presumptive therapy. Here we review the epidemiology, pathogenesis, morbidity and mortality of systemic Candida infections in the ICU setting, and examine predisposing risk factors. Antifungal treatment, including the use of amphotericin B, flucytosine and fluconazole, and the roles of early presumptive therapy and prophylaxis, is also reviewed.

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Section: Pathogenesis Of Invasive Candida Infectionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Epidemiology, diagnosis and treatment of systemic Candida infection in surgical patients under intensive care

et al. 1998

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“…Impaired T cell function owing to factors such as high-dose glucocorticoid therapy, chemotherapy or acquired immunodeficiency syndrome as well as depressed neutrophil number or function from causes such as haematological malignancies and chemotherapy may increase the risk of fungal infection. 6 The use of multiple broad-spectrum antimicrobial agents in critically ill patients may alter the normal flora in the GI tract and precipitate fungal infection, and is an important factor in the increasing occurrence of fungal infection in patients with a ruptured oesophagus, who are usually on long-term antimicrobial therapy. 6 …”

Section: Discussionmentioning

confidence: 99%

The impact of systemic fungal infection in patients with perforated oesophagus

Elsayed

Shaker

Whittle

et al. 2012

annals

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INTRODUCTIONPerforated oesophagus is a surgical emergency with significant morbidity and mortality. Systemic fungal infection represents a poor response to the magnitude of the insult, which adds significantly to the risk of morbidity and mortality in these patients. We reviewed our experience with this group of patients over a six-year period in a tertiary referral centre.METHODSA retrospective clinical review was conducted of patients who were admitted following a ruptured oesophagus over a period of six years (January 2002 – January 2008).RESULTSWe had 27 admissions (18 men and 9 women) following an isolated perforated oesophagus to our unit. The median patient age was 65 years (range: 22–87 years). The majority (n=24,89%) presented with spontaneous perforations (Boerhaave’s syndrome) and three (11%) were iatrogenic. Fungal organisms, predominantly Candida albicans, were positively cultured in pleural or blood samples in 16 (59%) of the 27 patients. Fourteen patients grew yeasts within the first seven days while two showed a delayed growth after ten days. Overall mortality was 5 out of 27 patients (19%). There was no mortality among the group that did not grow yeasts in their blood/pleural fluid while mortality was 31% (5/16) in the group with systemic fungal infection (p<0.001). A positive fungal culture was also associated with increase ventilation time, intensive care unit stay and inpatient hospital stay but not an increased rate of complications.CONCLUSIONSSystemic fungal infection in patients with a ruptured oesophagus affects a significant proportion of these patients and carries a poor prognosis despite advanced critical care interventions. It may represent a general marker of poor host response to a major insult but can add to mortality and morbidity. It is worth considering adding antifungal therapy empirically at an early stage to antimicrobials in patients with an established diagnosis of a perforated oesophagus.

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“…Candida may be frequently identified in the microflora of the gastrointestinal tract in the normal human host. Alterations of host defences, such as modification of the normal bacterial flora by broad spectrum antibiotics or immunosuppression by chemotherapy or chemoradiotherapy, may lead to overgrowth of Candida species in the gut which is a prerequisite for systemic infection 2 …”

Section: Introductionmentioning

confidence: 99%

“…Alterations of host defences, such as modification of the normal bacterial flora by broad spectrum antibiotics or immunosuppression by chemotherapy or chemoradiotherapy, may lead to overgrowth of Candida species in the gut which is a prerequisite for systemic infection. 2 Esophageal surgery may represent an important risk factor for Candida infection, especially in critical patients requiring ICU admission during the postoperative period. Given the lack of strong epidemiological data, no guidelines exist for prophylaxis against Candida in these patients.…”

Section: Introductionmentioning

confidence: 99%

Candida colonization in patients with esophageal disease: a prospective clinical study

Bonavina

Incarbone

Reitano

et al. 2003

Diseases of the Esophagus

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The incidence of Candida infection has significantly increased over the recent years, becoming the fourth most common pathogens isolated in patients admitted to intensive care units (ICU). Mortality rates ranging between 6 and 38% have been reported to be associated with candidemia. Esophageal surgery may increase the risk of systemic Candida infection in critical patients requiring postoperative ICU admission. The aim of the present study was to assess the prevalence of Candida colonization in patients with esophageal disease undergoing surgery. Between April 1999 and April 2001, 131 patients with esophageal disease and 40 healthy volunteers were prospectively tested for Candida colonization by oral and pharyngeal swab. Candida colonization was significantly more frequent in patients with esophageal disease than in control subjects (38.9 vs 7.5%, P < 0.01); the prevalence was higher in individuals with carcinoma than in those with benign disease (51.8 vs 24%, P < 0.02), and in patients undergoing neoadjuvant chemoradiation therapy compared to those having primary surgery (55.5 vs 34.4%, P < 0.01). These data suggest that Candida colonization of the gastrointestinal tract is common in patients with esophageal disease. Pharmacological attempts to prevent or reduce the magnitude of this event may be worthwhile before surgery. However, the hypothesis that antifungal oral prophylaxis with nonabsorbable drugs may lower the incidence of candidemia in patients with gastrointestinal Candida colonization, especially in those candidates to postoperative ICU admission, should be tested by randomized double-blinded studies.

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Life-threatening Candida Infections in the Intensive Care Unit

Cited by 6 publications

References 80 publications

Epidemiology, diagnosis and treatment of systemic Candida infection in surgical patients under intensive care

Epidemiology, diagnosis and treatment of systemic Candida infection in surgical patients under intensive care

The impact of systemic fungal infection in patients with perforated oesophagus

Candida colonization in patients with esophageal disease: a prospective clinical study

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