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Candida infection in surgical patients

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Abstract

Candida infections have become a common and serious problem in non-neutropenic general surgical patients. This paper reviews the etiologic factors, pathogenesis of systemic candidiasis, and the more common syndromes of infection in surgical patients. Prophylactic and systemic therapy is detailed. The most significant factor inCandida infections is depression of host immune function. Significant abnormalities of T-cells, monocytes, and neutrophils have been described in patients with systemicCandida infection and in patients shown to be at high risk of such infection (burned, malnourished, or septic patients). Systemic infection is a consequence of high density colonization at 1 or more sites. Topical therapy with nystatin, amphotericin B, or the imidazole derivatives is usually effective in terminating local colonization of skin lesions, the gastrointestinal tract, or the bladder. If local colonization is not controlled, the patient may progress to systemic infection. The primary diagnostic difficulty is determining when conversions to systemic infection has occurred. Serologic testing and blood culture techniques appear to be of value only late in the course of infection. For this reason, the assessment of culture results from multiple sites appears to be of value. Treatment is begun with systemic amphotericin if the patient is immunodepressed or has ≥ 3 sites positive forCandida. In nonneutropenic patients, relatively short therapy appears effective. Treatment of endocarditis requires several (4–6) weeks of therapy, and current evidence suggests that early surgery with valve replacement may improve survival.

Résumé

Les infections à Candida sont devenues fréquentes et graves chez les patients chirurgicaux non neutropéniques. L’article revoit l’étiologie et la pathogénie des infections généralisées à Candida, leurs manifestations cliniques les plus fréquentes en chirurgie, la prophylaxie et la thérapeutique. Le facteur étiologique le plus important est la dépression des défenses immunitaires. Des anomalies significatives des cellules T, des monocytes et des neutrophiles ont été décrites chez les malades atteints d’infection généralisée à Candida et chez les malades susceptibles de développer ce type d’infection (patients brûlés, infectés ou en état de malnutrition). L’infection généralisée se produit par dissémination à partir d’un ou plusieurs foyers fortement contaminés. Les traitements locaux à la nystatine, à l’amphotéricine B, aux dérivés de l’imidazol sont, en général, capables de stériliser les foyers au niveau de la peau, du tube digestif, de la vessie. Si ces foyers ne sont pas contrôlés, l’infection peut se généraliser. Mais il est difficile de savoir quand on passe de l’infection locale à l’infection systémique. Les tests sérologiques et les hémocultures ne paraissent être valables que relativement tard. Il parait donc utile de tabler sur les résultats de cultures obtenues à partir de plusieurs foyers. Si le malade est immunodéprimé et s’il a au moins 3 foyers d’infection à Candida, il faut administrer l’amphotéricine par voie générale. Un traitement de courte durée parait être efficace chez le malade non neutropénique. Pour l’endocardite, il faut plusieurs semaines (4–6) de traitement et les données actuelles suggèrent qu’une chirurgie précoce de remplacement valvulaire améliore la survie.

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  1. Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA

    Joseph S. Solomkin M.D. & Richard L. Simmons M.D.

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Dr. Solomkin is supported by U.S. Public Health Service Fellowship Number IF 32 AM 05696-01.

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Solomkin, J.S., Simmons, R.L. Candida infection in surgical patients. World J. Surg. 4, 381–392 (1980). https://doi.org/10.1007/BF02393155

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