Postoperative candidiasis.

Abstract

Candida species are important opportunistic pathogens in compromised hosts, such as patients recovering from major abdominal surgery. The incidence, pathogenesis, diagnosis and prognosis of postoperative candidiasis were studied in a general surgical department. Transplantation surgery was not included. The mean incidence of postoperative candidiasis in abdominal surgery was 6.2 per 1000 laparotomies. The estimated incidence was higher during the years 1987-1992 than 1981-1986. Postoperative candidiasis was most often encountered in patients undergoing surgery of the small intestine or pancreas. These patients had certain typical features: a long hospitalization before signs, central catheterization, parenteral nutrition, prolonged antibiotic therapy and reoperations; malignancy, corticosteroid or immunosuppressive therapy were uncommon. Multiple blood cultures during reoperations were not found to yield Candida; hence, hematogenous dissemination from the gut was not seen. The prognosis of postoperative candidiasis was poor: the infection mortality was 70-79% and significantly higher than in patients with postoperative bacterial septicemia. Early therapeutic measures resulted in a significantly better prognosis as compared to delayed treatment. Arabinitol was found a specific marker of candidiasis, but because sequential samples were needed for adequate sensitivity, a single arabinitol concentration determination in the beginning of the disease was not useful. Febrile patients who had Candida in any sample during the first postoperative week had a poor prognosis. The results show that patients with candidiasis have typical clinical features that facilitate suspicion. Antifungal therapy is mandatory and must be started as soon as a suspicion of candidiasis has risen, before the results of specific laboratory tests are available.