title: Outcome and management of invasive candidiasis following oesophageal perforation.
abstract: The regular colonisation of the oesophagus with a Candida species can, after oesophageal perforation, result in a contamination of the mediastinum and the pleura with a Candida species. A patient cohort of 80 patients with oesophageal perforation between 1986 and 2010 was analysed retrospectively. The most common sources with positive results for Candida were mediastinal biopsies and broncho-alveolar secretions. Candida species were detected in 30% of the patients. The mortality rate was 41% in patients with positive microbiology results for Candida, whereas it was 23% in the remaining patient cohort. This difference did not reach statistical significance (P = 0.124). Mortality associated with oesophageal perforation was attributed mainly to septic complications, such as mediastinitis and severe pneumonia. During the study period we observed a shift towards non-albicans species that were less susceptible or resistant to fluconazole. In selected patients with risk factors as immunosuppression, granulocytopenia and long-term intensive-care treatment together with the finding of Candida, an antimycotic therapy should be started. A surgical approach offers the possibility to obtain deep tissue biopsies. The antimycotic therapy should start with an echinocandin, as the resistance to fluconazole is growing and to cover non-albicans Candida species, too.
authors.affiliation: Surgery/Thoracic Surgery, University Clinic of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany. drmartinhoffmann@googlemail.com
authors.forename: Martin
authors.initials: M
authors.lastname: Hoffmann
authors.forename: Peter
authors.initials: P
authors.lastname: Kujath
authors.forename: Florian-M
authors.initials: FM
authors.lastname: Vogt
authors.forename: Tilman
authors.initials: T
authors.lastname: Laubert
authors.forename: Stefan
authors.initials: S
authors.lastname: Limmer
authors.forename: Thomas
authors.initials: T
authors.lastname: Mulrooney
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Bruch
authors.forename: Thomas
authors.initials: T
authors.lastname: Jungbluth
authors.forename: Erik
authors.initials: E
authors.lastname: Schloericke
mesh_terms: D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000302:isolation & purification; D018407:Bacterial Physiological Phenomena; D002175:Candida / Q000187:drug effects / Q000302:isolation & purification / Q000502:physiology; D058365:Candidiasis, Invasive / Q000188:drug therapy* / Q000209:etiology* / Q000382:microbiology / Q000401:mortality; D004939:Esophageal Perforation / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents