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.

Microbiological Analysis of Fluids in Postsurgical Gastroesophageal Intrathoracic Leaks Obtained by Endoscopy: A New Way to Optimize Antibiotic Therapy

“…in the leakage of the mediastinum. The frequent detection of Candida is in concordance with another study reporting an invasive candidiasis diagnosed by deep biopsies of the mediastinum in 30% of patients after esophageal perforation [14]. Another explanation may be the broad antibiotic pre-treatment on ICU.…”

Mediastinitis in the intensive care unit patient: a narrative review

“…This may require aspiration from deep abscess cavities or debridement of infected sternal or mediastinal tissues [29,30]. In more severe cases, pleural fluid or bronchoalveolar secretions may also be required [31]. When taken alone, superficial wound cultures should be interpreted with caution as they may represent wound colonization rather than infection and lead to inappropriate antibiotic therapy [30].…”

An exceptional complication of transesophageal ultrasound in a patient with Coronavirus disease

“…EP is a rare condition, and the incidence is estimated at 3 cases per million inhabitants per year, 3 but it remains a serious complication, associated with high mortality, mainly due to septic complications such as mediastinitis. 4 The main causes are increased intraesophageal pressure (spontaneous or Boerhaave syndrome), iatrogenic damage due to instrumentation, physical or chemical trauma, or diseases of the esophagus. 3 EP after TEE is extremely rare and commonly occurs in the cervical esophagus.…”