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Secondary mycosis in surgery: Treatment with fluconazole

Sekundäre Mykosen in der Chirurgie, Therapie mit Fluconazol

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Summary

Together with the severity of the underlying disease, mycotic infections are assuming increasing significance in surgical patients under intensive care. 26 patients with severe internal mycotic infections were treated with fluconazole in an open clinical trial. The pathogens isolated wereCandida albicans in 22 cases,Candida tropicalis in four,Torulopsis glabrata in three,Candida parapsilosis in two andAspergillus fumigatus in one. Mixed infections were found in five cases. Most of this series of surgical patients had a severe, life-threatening post-operative condition. Their mean classification by the Apache score was 15.35. The most frequent risk factors were previous injuries to intraabdominal hollow organs and extensive antibiotic therapy; and the peritoneum was, therefore, the commonest site of infection. Antimycotic therapy was with fluconazole at a dose of 200–400 mg daily for at least ten days. The mycosis was cured in 22 of the 26 patients, one of these being a case of severe mycotic peritonitis. Nine patients died of the underlying disease within four weeks of the beginning of treatment. Fluconazole was effective and well tolerated in the treatment of severe life-threatening infections in surgical patients.

Zusammenfassung

Mit der Schwere der Grunderkrankung gewinnen begleitende Pilzinfektionen bei chirurgisch, intensivmedizinisch betreuten Patienten zunehmend an Bedeutung. In einer Studie wurden 26 Patienten wegen einer schweren, inneren Mykose mit Fluconazol behandelt. Als Erreger wurden isoliert:Candida albicans (n=22),Candida tropicalis (n=4),Torulopsis glabrata (n=3),Candida parapsilosis (n=2) undAspergillus fumigatus (n=1). In fünf Fällen lag eine Mischinfektion vor. Das chirurgische Krankengut zeigte im postoperativen Zustand ein zumeist lebensbedrohliches Krankheitsbild. Die Klassifizierung nach dem Apache-Score ergab einen Mittelwert von 15,35. Häufigste Risikofaktoren waren vorangegangene Verletzungen intraabdomineller Hohlorgane und eine ausgiebige antibiotische Therapie. Das Peritoneum war deshalb die bevorzugte Lokalisation. Die Therapie der Mykosen erfolgte mit Fluconazol in der Dosierung 200–400 mg/d über mindestens zehn Tage. 22 von 26 Patienten konnten von der Mykose geheilt werden, darunter ein Patient mit einer ausgeprägten Candidaperitonitis. Neun Patienten verstarben bis zu vier Wochen nach Beginn der Therapie an ihrer Grunderkrankung. Fluconazol ist in der Behandlung lebensbedrohlicher, schwerer Pilzinfektionen in der Chirurgie gut wirksam und verträglich.

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Dedicated to Prof. Dr.H. P. R. Seeliger for his 68th birthday, director of the Institute of Hygiene and Microbiology of the University of Würzburg.

Supported by Pfizer GmbH, FR-Germany

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Kujath, P., Lerch, K. Secondary mycosis in surgery: Treatment with fluconazole. Infection 17, 111–117 (1989). https://doi.org/10.1007/BF01646895

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Keywords

  • Candida
  • Fluconazol
  • Candida Tropicalis
  • Candida Parapsilosis
  • Mycotic Infection