Authors: YanShen Shan Edgar D Sy ShanTair Wang JenqChang Lee PinWen Lin
Publish Date: 2005/12/16
Volume: 30, Issue: 1, Pages: 119-126
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 875 of the isolated Candida species 846 in the EPT+ group and 895 in the EPT− group In the EPT+ group the positive blood culture rate was 667 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 0001 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
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