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Candida infection of the central nervous system following neurosurgery: a 12-year review

  • Clinical Article
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Abstract

Background

Candida infection of the central nervous system (CNS) following neurosurgery is relatively unusual but is associated with significant morbidity and mortality. We present our experience with this infection in adults and discuss clinical characteristics, treatment options, and outcome.

Methods

All episodes of Candida isolated from the central nervous system were identified by searching our laboratory database. Review of the cases was performed by means of a retrospective chart review.

Results

Eleven episodes of Candida CSF infection following neurosurgery were identified over a 12-year period. Candida albicans was the predominant species isolated (n = 8, 73%). All infections were associated with foreign intracranial material, nine with external ventricular drains (82%), one with a ventriculoperitoneal shunt, one with a lumbar drain, and one with Gliadel wafers (1,3-bis [2-chloroethyl]-1-nitrosurea). Fluconazole or liposomal amphotericin B were the most common anti-fungal agents used. The mortality rate identified in our series was 27%.

Conclusions

Candida infection following neurosurgery remains a relatively rare occurrence but one that causes significant mortality. These are complex infections, the management of which benefits from a close liaison between the clinical microbiologist and neurosurgeon. Prompt initiation of antifungal agents and removal of infected devices offers the best hope of a cure.

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Authors and Affiliations

  1. Department of Clinical Microbiology, Beaumont Hospital, Dublin 9, Ireland

    Deirdre O’Brien, Edmond Smyth, Fidelma Fitzpatrick & Hilary Humphreys

  2. Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, RCSI Education & Research Centre, Beaumont Hospital, Dublin 9, Ireland

    Deirdre O’Brien, Niall T. Stevens, Edmond Smyth, Fidelma Fitzpatrick & Hilary Humphreys

  3. National Centre for Neurosurgery, Beaumont Hospital, Dublin 9, Ireland

    Chor Hiang Lim & Donncha F. O’Brien

  4. The Health Protection Surveillance Centre, Dublin 1, Ireland

    Fidelma Fitzpatrick

Authors
  1. Deirdre O’Brien
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  2. Niall T. Stevens
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  3. Chor Hiang Lim
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  4. Donncha F. O’Brien
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  5. Edmond Smyth
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  6. Fidelma Fitzpatrick
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  7. Hilary Humphreys
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Corresponding author

Correspondence to Deirdre O’Brien.

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O’Brien, D., Stevens, N.T., Lim, C.H. et al. Candida infection of the central nervous system following neurosurgery: a 12-year review. Acta Neurochir 153, 1347–1350 (2011). https://doi.org/10.1007/s00701-011-0990-9

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  • DOI: https://doi.org/10.1007/s00701-011-0990-9

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