Stellenwert der Mykosen bei intraabdominalen Infektionen

Abstract

Although there is a 20% yeast colonization in the gastrointestinal tract of the population, fungal infections appear only rarely in secondary peritonitis. The risk of severe mycosis increases after a major operation and when a patient is taking broad-spectrum antibiotics, is on total parenteral nutrition, is catheterized, and/or is immune-suppressed. In the past years the incidence of nosocomial fungal infections (usually Candida spp.) has risen significantly. Five percent of CAPD-related peritonitis is caused by fungi. In enteral anastomosis breakdown, invasive mycosis occurs more often, with an accompanying lethality of up to 80%. In severe pancreatitis, up to 5% of peripancreatic necrosis is infected with fungi. The clinical course of severe mycosis, like the septic syndrome, is associated with fungemia in up to 50% of cases. As most of the facultative pathogenic fungi are part of the physiological flora, it is difficult to interpret mycological cultures. In order to diagnose invasive fungal infections, histopathological techniques and serologic tests for antigens and antibodies are available. Three antifungal agents (amphotericin B, flucytosine, fluconazole) are available for intravenous administration. Amphotericin B is given at doses of up to 1 mg/kg per day, in liposomal galenism up to 3 mg/kg per day. Combining amphotericin B with flucytosine (150-200 mg/kg per day) a synergistic effect is reached. Fluconazole at a dosage of 200-800 mg per day represents an alternative with similar antifungal activity and lower side effects.

Erschwerter Verlauf von Ösophagusperforationen durch Pilzinfektion

“…So wurden bei 17% von chirurgischen Intensivpatienten schwere Pilzinfektionen vor allem mit Candida spp. beobachtet 20 …”

Schwere, sklerosierende Candida‐peritonitis nach CAPD – ein glücklicher Verlauf

“…Die Inzidenz einer Pilzperitonitis bei CAPD‐Patienten beträgt ca. 5% aller intraabdominellen Infektionen 7 und nimmt weiter zu. Die Autoren beschreiben eine schwere Candida ‐Peritonitis ( Candida albicans ) bei einem Patienten unter CAPD.…”

“…This is a nosocomial infection with a high lethality rate of about 60% 4–6 . The incidence of Candida peritonitis in CAPD patients amounts to approximately 5% of all intraabdominal infections 7 and is on the increase. The authors describe a severe case of Candida peritonitis in a patient on CAPD.…”