title: Necrotizing Candida infection after percutaneous endoscopic gastrostomy: a fatal and rare complication.
abstract: Gastrostomy site infections following percutaneous endoscopic gastrostomy (PEG) are the most common complication after PEG placement. Recent meta-analyses were able to show that PEG site infections can be reduced significantly with a systemic antimicrobial prophylaxis. This mostly cephalosporin- or penicillin-based prophylaxis does not cover fungal infections. Although Candida skin infections after PEG placement are rarely described, a mucosal colonization or infection of the upper GI tract with Candida species is very common, especially in severely ill patients such as those requiring artificial nutrition. The authors report a rare and lethal case of a necrotizing PEG site infection with Candida albicans in a patient with diabetes with multiple comorbidities, presenting like gas gangrene. In patients with probable immunodeficiency or visible candidiasis of the skin, oropharynx, or esophagus, a Candida infection should be considered in case of a gastrostomy site infection.
authors.affiliation: Clinic for Internal Medicine and Geriatrics, St Marien-Hospital Borken, Borken, Germany. rainer.wirth@hospital-borken.de
authors.forename: Rainer
authors.initials: R
authors.lastname: Wirth
authors.forename: Jürgen
authors.initials: J
authors.lastname: Bauer
authors.forename: Cornel
authors.initials: C
authors.lastname: Sieber
mesh_terms: D000368:Aged; D019072:Antibiotic Prophylaxis; D002176:Candida albicans / Q000254:growth & development*; D002177:Candidiasis / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D004724:Endoscopy / Q000009:adverse effects; D004866:Equipment Contamination; D017809:Fatal Outcome; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000150:complications / Q000175:diagnosis* / Q000401:mortality