Systemic candidiasis in cardiac surgery patients.
OBJECTIVE
To examine the frequency, predisposing factors and consequences of systemic candidiasis in cardiac surgery patients. We also examined fluconazole efficacy in the treatment of disseminated fungal disease.


METHODS
A total of 2615 adult patients of mean +/- S.D. age 60.8 +/- 8.7 years who underwent open heart surgery between July 1993 and April 1995, were enrolled in the initial protocol. Patients were divided in two groups according to length of stay in the intensive care unit (ICU). The cut-off was a length of stay of 9 days.


RESULTS
In the group of patients with prolonged stay (n = 54), 11 patients (20.3%) developed systemic candidiasis, usually after the twentieth postoperative day. Predisposing factors were patient age, history of diabetes mellitus, presence of central venous catheters, prolonged mechanical ventilatory support, prolonged ICU stay, and administration of antibiotics and of total parenteral nutrition for a prolonged period. The patients who developed systemic candidiasis had a median ICU and hospital stay of 58 and 60 days respectively. The mortality rate was 27.2%. Patients receiving fluconazole, improved and eventually negative cultures were obtained.


CONCLUSIONS
We concluded that a significant percentage of patients who remained in the cardiothoracic ICU for more than 9 days developed systemic candidiasis. Systemic candidiasis resulted in a significant prolongation of ICU and hospital length of stay, thus increasing extensively total hospitalization costs. Fluconazole seems to be an effective and well-tolerated agent in the treatment of severe life-threatening systemic candidiasis, and a very good alternative to amphotericin B, in cardiac surgery patients.
Michalopoulos
A
A
Cardiothoracic ICU, Onassis Cardiac Surgery Center, Athens, Greece.
Kriaras
J
J
Geroulanos
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage; D002177:Candidiasis / Q000188:drug therapy / Q000209:etiology*; D003422:Critical Care; D003428:Cross Infection / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage; D006331:Heart Diseases / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000188:drug therapy / Q000209:etiology*; D012307:Risk Factors; D016896:Treatment Outcome
D000935:Antifungal Agents; D015725:Fluconazole