Rantala A
Department of Surgery, University of Turku, Finland.
Ann Chir Gynaecol Suppl. 1993;205:1-52.
Candida species are important opportunistic pathogens in compromised hosts, such as patients recovering from major abdominal surgery. The incidence, pathogenesis, diagnosis and prognosis of postoperative candidiasis were studied in a general surgical department. Transplantation surgery was not included. The mean incidence of postoperative candidiasis in abdominal surgery was 6.2 per 1000 laparotomies. The estimated incidence was higher during the years 1987-1992 than 1981-1986. Postoperative candidiasis was most often encountered in patients undergoing surgery of the small intestine or pancreas. These patients had certain typical features: a long hospitalization before signs, central catheterization, parenteral nutrition, prolonged antibiotic therapy and reoperations; malignancy, corticosteroid or immunosuppressive therapy were uncommon. Multiple blood cultures during reoperations were not found to yield Candida; hence, hematogenous dissemination from the gut was not seen. The prognosis of postoperative candidiasis was poor: the infection mortality was 70-79% and significantly higher than in patients with postoperative bacterial septicemia. Early therapeutic measures resulted in a significantly better prognosis as compared to delayed treatment. Arabinitol was found a specific marker of candidiasis, but because sequential samples were needed for adequate sensitivity, a single arabinitol concentration determination in the beginning of the disease was not useful. Febrile patients who had Candida in any sample during the first postoperative week had a poor prognosis. The results show that patients with candidiasis have typical clinical features that facilitate suspicion. Antifungal therapy is mandatory and must be started as soon as a suspicion of candidiasis has risen, before the results of specific laboratory tests are available.
念珠菌属是免疫功能低下宿主（如接受腹部大手术康复的患者）中的重要机会致病菌。我们在一个普通外科对术后念珠菌病的发病率、发病机制、诊断和预后进行了研究。移植手术未纳入研究范围。腹部手术中术后念珠菌病的平均发病率为每1000例剖腹手术中有6.2例。据估计，1987 - 1992年期间的发病率高于1981 - 1986年。术后念珠菌病最常出现在接受小肠或胰腺手术的患者中。这些患者有一些典型特征：出现症状前住院时间长、中心静脉置管、肠外营养、长期抗生素治疗及再次手术；恶性肿瘤、皮质类固醇或免疫抑制治疗并不常见。再次手术时多次血培养未发现念珠菌；因此，未观察到念珠菌从肠道的血行播散。术后念珠菌病的预后较差：感染死亡率为70 - 79%，显著高于术后细菌性败血症患者。与延迟治疗相比，早期治疗措施的预后明显更好。阿拉伯糖醇被发现是念珠菌病的一个特异性标志物，但由于需要连续采样以获得足够的敏感性，在疾病初期单次测定阿拉伯糖醇浓度并无用处。术后第一周内任何样本中发现念珠菌的发热患者预后较差。结果表明，念珠菌病患者具有便于怀疑的典型临床特征。抗真菌治疗是必需的，一旦怀疑念珠菌病，必须在获得特异性实验室检查结果之前尽早开始治疗。
