[Invasive candidiasis: its predisposing factors, usefulness and limitation of cultural study in its diagnosis, and consideration on the appropriate amphotericin B therapy].
We have reviewed 38 patients with invasive candidiasis and examined its predisposing factors, usefulness and limitation of cultural study in its diagnosis, and effective usage of amphotericin B in its treatment. Invasive candidiasis was diagnosed in 2.4% of the patients admitted during the past 5 years. One of the most important predisposing factors for development of invasive candidiasis was extensive use of antibiotics. Destruction of the mechanical barrier against bacteria and fungi caused by endotracheal intubations and various catheterization was another important factor. Mucosal lesion of the gastrointestinal tract, including stress ulcer, non-specific inflammatory bowel disease and esophageal ulcer, was seen in 30% of the patients. These lesions were thought to be the portal of entry for candida to systemic dissemination. AMPH is the most effective antifungal agent. Total dose of 300 to 1000 mg was effective in the patients. Dosage over 1000 mg was associated with progressive decrease in creatinine clearance. This decrease was irreversible even after discontinuation of AMPH. Candidal overgrowth within the G1 tract was considered to precede invasive candidiasis. Oral AMPH administration was effective in such conditions.
Department of Traumatology, Osaka University School of Medicine, Japan.
K
K
Ikegami
T
T
Tabata
S
S
Shiono
H
H
Sugimoto
T
T
Yoshioka
T
T
Sugimoto
D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D002177:Candidiasis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D002404:Catheterization / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
D000900:Anti-Bacterial Agents; D000666:Amphotericin B