SYSTEMIC CANDIDIASIS IN CARDIAC-SURGERY PATIENTS

Objective: To examine the frequency, predisposing factors and conseque nces of systemic candidiasis In cardiac surgery patients. We also exam ined fluconazole efficacy in the treatment of disseminated fungal dise ase. Methods: A total of 2615 adult patients of mean +/- S.D. age 60.8 +/- 8.7 years who underwent open heart surgery between July 1993 and April 1995, were enrolled in the initial protocol. Patients were divid ed in two groups according to length of stay in the intensive care uni t (ICU). The cut-off was a length of slay of 9 days. Results: In the g roup of patients with prolonged stay (n = 54), 11 patients (20.3%) dev eloped systemic candidiasis, usually after the twentieth postoperative day. Predisposing factors were patient age, history of diabetes melli tus, presence of central venous catheters, prolonged mechanical ventil atory support, prolonged ICU stay, and administration of antibiotics a nd of total parenteral nutrition for a prolonged period. The patients who developed systemic candidiasis had a median ICU and hospital stay of 58 and 60 days respectively. The mortality rate was 27.2%. Patients receiving fluconazole, improved and eventually negative cultures were obtained. Conclusions: We concluded that a significant percentage of patients who remained in the cardiothoracic ICU for more than 9 days d eveloped systemic candidiasis. Systemic candidiasis resulted in a sign ificant prolongation of ICU and hospital length of stay, thus increasi ng extensively total hospitalization costs. Fluconazole seems to be an effective and well-tolerated agent in the treatment of severe life-th reatening systemic candidiasis, and a very good alternative to amphote ricin B, in cardiac surgery patients. (C) 1997 Elsevier Science B.V.