Candida in pancreatic infection: a clinical experience.
Pancreatic infection remains a significant clinical problem, with substantial morbidity and mortality. Published case reports of Candida species identified in these infections prompted a review of 17 consecutive patients recently treated for peripancreatic infection by scheduled relaparotomy. Six patients were transferred from other hospitals, all having undergone prior operative intervention (median stay elsewhere: 58 days). The 11 other patients underwent initial operation an average of 14 days after admission. Candida species were identified in the initial operative cultures of 5 patients (29%), three of whom had undergone previous drainage at other hospitals. Two patients (11.7%) had Candida identified at subsequent operation. Six patients were treated with Amphotericin B for a median of 12 days (range 6-32) and a median dosage of 420 mg (range 225-830 mg). All patients were cleared of their Candida infection, but three subsequently died, for an overall mortality of 17.6%. Candida infected patients suffered a 42 per cent mortality. Our series supports the suspicion that Candida is much more frequent (41% of patients) than previously recognized in peripancreatic sepsis, and is commonly acquired after the initial operation. Amphotericin B therapy is effective in clearing Candida infection, but affected patients have a high associated mortality.
Aloia
T
T
Department of Surgery, UCLA Center for Health Sciences 90024-1749.
Solomkin
J
J
Fink
A S
AS
Nussbaum
M S
MS
Bjornson
S
S
Bell
R H
RH
Sewak
L
L
McFadden
D W
DW
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D002177:Candidiasis / Q000175:diagnosis; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004322:Drainage; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010195:Pancreatitis / Q000382:microbiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D012086:Reoperation / Q000379:methods* / Q000401:mortality; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
D000666:Amphotericin B