Objective: Several surgical procedures into abdominal cavity are associated with a high incidence of fungal infections. The aim of the study is to analyse the clinical an microbiological aspects of patients with abdominal fungal infections after surgical procedures. Material and methods: We investigated retrospectively forty-five patients, admitted to the Surgical Digestive Service for urgent selective surgery. Clinical investigation included: host and risk factors, history of the disease, surgical procedures, postoperative complications, intraocular findings. Microbiological criterion included: positive cultures from intra-abdominal liquids and tissues, intraocular and blood samples. Bacteriological and mycological tests included cultures for aerobic and anaerobic, yeast and fungi. Fungal isolates were identified using standard mycologic laboratory methods and tested for susceptibility to fluconazol (FCZ), amphotericin B (AMB), itraconazol (IT), 5-fluorocytosine (5FC) and voriconazol (VOR). Results: The most commonly identified yeast species were Candida albicans (64%), followed by Candida glabrata (21%), Candida tropicalis (6%), Candida parasilopsis (3%), Candida krusei (2%), other species (4%). In 67% patients coexisted yeast and bacteria, and in 33% pure yeast culture was found. The bacteria most frequently associated were enterobacteria (26%), enterococcus (25%), non fermenting gram negative rods (18%), gram positive cocci (20%), other (2%). The predominant fungal association was C. albicans/C. glabrata (64%), C. albicans/C. tropicalis (24%). All the yeast isolated showed susceptibility to fluconazol except 50% isolates of C. glabrata and one C. krusei isolate. From the forty-five patients 45% showed post-surgical complications, 33% perforation of hollow viscus, 11% pancreatitis, and 11% biliary pathology. Five patients showed invasive fungal infection, one presented mediastinitis and three died. Conclusions: High percentage of C. glabrata isolated in intra-abdominal infections precludes the election of fluconazol as empiric antifungal treatment in most severe cases.
Full conference title:
16th European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 16th (2006)