title: Candida infection of the central nervous system following neurosurgery: a 12-year review.
abstract: BACKGROUND
  Candida infection of the central nervous system (CNS) following neurosurgery is relatively unusual but is associated with significant morbidity and mortality. We present our experience with this infection in adults and discuss clinical characteristics, treatment options, and outcome.
  
  
  METHODS
  All episodes of Candida isolated from the central nervous system were identified by searching our laboratory database. Review of the cases was performed by means of a retrospective chart review.
  
  
  RESULTS
  Eleven episodes of Candida CSF infection following neurosurgery were identified over a 12-year period. Candida albicans was the predominant species isolated (n = 8, 73%). All infections were associated with foreign intracranial material, nine with external ventricular drains (82%), one with a ventriculoperitoneal shunt, one with a lumbar drain, and one with Gliadel wafers (1,3-bis [2-chloroethyl]-1-nitrosurea). Fluconazole or liposomal amphotericin B were the most common anti-fungal agents used. The mortality rate identified in our series was 27%.
  
  
  CONCLUSIONS
  Candida infection following neurosurgery remains a relatively rare occurrence but one that causes significant mortality. These are complex infections, the management of which benefits from a close liaison between the clinical microbiologist and neurosurgeon. Prompt initiation of antifungal agents and removal of infected devices offers the best hope of a cure.
authors: Department of Clinical Microbiology, Beaumont Hospital, Dublin 9, Ireland. de.obrien@svuh.ie
authors: Deirdre
authors: D
authors: O'Brien
authors: Niall T
authors: NT
authors: Stevens
authors: Chor Hiang
authors: CH
authors: Lim
authors: Donncha F
authors: DF
authors: O'Brien
authors: Edmond
authors: E
authors: Smyth
authors: Fidelma
authors: F
authors: Fitzpatrick
authors: Hilary
authors: H
authors: Humphreys
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001927:Brain Diseases / Q000601:surgery*; D002177:Candidiasis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007494:Ireland; D008297:Male; D016921:Meningitis, Fungal / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D008875:Middle Aged; D019736:Prostheses and Implants / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D000935:Antifungal Agents