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DOI: 10.1055/s-2000-8934
Die invasive Candidainfektion chirurgischer Patienten: Eine valide klinische Entität
Publication History
Publication Date:
31 December 2000 (online)
Zusammenfassung.
Ziel der Studie: Erarbeitung einer Falldefinition für das Krankheitsbild der invasiven Candidose im intensivmedizinischen, chirurgischen Krankengut. Methodik: Im Zeitraum von 1996-1999 wurden 8 Fälle von invasiver postoperativer Candidose beobachtet, die im Hinblick auf diagnostische Kriterien und Ansprechen auf antimykotische Therapie ausgewertet wurden. Ergebnisse: Es handelte sich um 3 Frauen und 5 Männer, das mittlere Lebensalter betrug 62,7 (37 - 85) Jahre. Bei den Candida-Infektionen handelte es sich in 5 Fällen um eine Peritonitis nach operativer Eröffnung bzw. Perforation des Magen-Darm-Trakts, in 3 Fällen um eine Candida-Pneumonie unter Beatmung. Der Candida-Antigentest (Ramco) im Serum war nur in 2/8 Fällen positiv. Durch i. v.-Therapie mit Fluconazol kam es in 7 Fällen zur Heilung bzw. Besserung, eine bereits initial schwerkranke Patientin verstarb bei nicht beherrschter Infektion im Multiorganversagen. Mit Ausnahme des letal verlaufenen Falles zeigten alle Fälle einen erhöhten Candida-Antikörpertiter im Serum, wodurch das Vorliegen einer invasiven Infektion bewiesen wurde. Schlussfolgerung: Anhand der vorgestellten Verläufe wird folgende Definition einer invasiven Candidose im chirurgischen Krankengut vorgeschlagen: (1) Klinisch relevante postoperative Infektionssymptomatik, (2) kein Nachweis relevanter bakterieller Erreger und/oder fehlendes Ansprechen auf Breitbandantibiotika, (3) Nachweis von Candida spp. in normalerweise sterilen Materialien bzw. reichlicher Nachweis in Trachealsekret, (4) Ansprechen auf antimykotische Therapie und (5) signifikanter Anstieg des Candida-Antikörpertiters im Serum. Die genannte Definition erwies sich im eigenen Krankengut als valide und könnte in Zukunft als Einschlusskriterium für klinische Studien zur Optimierung der serologischen Candida-Diagnostik oder zur antimykotischen Therapie Verwendung finden.
Invasive Candidosis in Postsurgical Patients A Valid Clinical Entity.
Objective: Establishment of a case definition for invasive candidosis in postsurgical intensive care patients. Methods: During the period of 1996 - 1999, 8 cases of invasive candidosis were observed on a surgical intensive care unit. Patient records were evaluated with respect to diagnostic criteria and response to antimycotic therapy. Results: Patients included 3 women and 5 men with a mean age of 62.7 (37 - 85) years. Candida peritonitis (n = 6) occurred after surgery or perforation of the intestinal tract, and Candida pneumonia was due to artifical ventilation (n = 3). C. albicans was isolated in all 8 cases, but mixed infections with other Candida spp. occurred in 3 cases. The Candida serum antigen test yielded a positive result in only 2/8 cases. I. v. therapy with fluconazole was successful in 7 cases, one patient with severe initial disease died with ongoing infection. With the exception of the lethal case, all patients showed a diagnostic serum antibody test, proving systemic candida infection. Conclusion: Based on the case descriptions, we propose the following definition of invasive candidosis: (1) Clinical signs of infection after surgery, (2) absence of bacterial pathogens and/or failure to respond to systemic antibiotics, (3) cultivation of Candida spp. from normally sterile sites or abundant growth in tracheal aspirate, (4) response to antimycotic therapy and (5) diagnostic serum antibody test. This definition proved to be valid for our patients and could be used as an inclusion criterion for future clinical studies of serodiagnosis of Candida infection or antimycotic chemotherapy.
Schlüsselwörter:
Candida albicans - Peritonitis - Beatmungspneumonie - Antimykotika
Key words:
Candida albicans - Peritonitis - Ventilator-associated pneumonia - Antifungal drugs
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Prof. Dr. med. Matthias Trautmann
Sektion Klinikhygiene, Universitätsklinkum Ulm
Steinhövelstraße 9
89075 Ulm
Email: matthias.trautmann@medizin.uni-ulm.de