Early presumptive therapy with fluconazole for occult Candida infection after gastrointestinal surgery

Yan-Shen Shan, Chun Wei Shih, Shan-Tair Wang, Jenq-Chang Lee, Pin Wen Lin

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

The objective of this retrospective comparative study was to improve the outcome of patients with suspected occult Candida infection after gastrointestinal surgery by early presumptive therapy. It was conducted in the National Cheng Kung University Hospital in Taiwan. A total of 36 patients with prolonged ileus with fever after gastrointestinal tract surgery between January 1995 and December 2002 were examined for two time periods: those treated before and those treated after January 1999. One set of patients did not receive early presumptive therapy (EPT) until Candida infection was confirmed, and they were designated EPT(-). Another group of patients with suspected occult Candida infection received EPT and were designated EPT(+). Fluconazole, 400 mg/ day, was given as EPT. Urine, wound, intraperitoneal drainage, and blood specimens were obtained from patients for fungus culture before starting treatment and weekly until symptoms subsided. The primary endpoints were the frequency of candidiasis and the persistence of candidemia; the secondary endpoint was the efficiency of EPT in the clinical outcome. There was no difference in Candida peritonitis, wound colonization, or urine colonization in the two treatment groups. Candida albicans accounted for 87.5% of the isolated Candida species: 84.6% in the EPT(+) group and 89.5% in the EPT(-) group. In the EPT(+) group, the positive blood culture rate was 66.7%. The fever subsided rapidly in 17 patients (94%), the hospital stay and intensive care unit stay were shorter, and the mortality decreased significantly: 11% vs. 78%, P < 0.001. Persistent gastrointestinal ileus was the main cause of breakthrough candidemia. We concluded that EPT with fluconazole improves the prognosis of patients with occult Candida infection after gastrointestinal surgery. Surgical intervention was required in patients with breakthrough candidemia.

Original languageEnglish
Pages (from-to)119-126
Number of pages8
JournalWorld journal of surgery
Volume30
Issue number1
DOIs
Publication statusPublished - 2006 Jan 1

All Science Journal Classification (ASJC) codes

  • Surgery

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