Peritonitis candidiásica | Enfermedades Infecciosas y Microbiología Clínica

Article information

Resumen

Debido a que Candida spp. es un componente de la flora endógena del tubo digestivo, puede formar parte de la etiología de prácticamente cualquier tipo de infección abdominal. Es frecuente, por ello, aislar Candida spp. en las peritonitis secundarias polimicrobianas por dehiscencia de suturas intestinales. En estos casos no hay acuerdo claro acerca de cuando el aislamiento de Candida spp. en drenajes peritoneales representa infección y no colonización. La recomendación general es interpretar que hay infección cuando la muestra en la que se identifica el germen es intraoperatoria o se ha obtenido mediante punción directa de la colección intraabdominal. Cuando se cultiva Candida spp. en las muestras de drenajes tomadas posteriormente es posible que se trate de una simple colonización. Sin embargo, cuando estos cultivos se acompañan de signos de sepsis, el paciente reúne criterios de gravedad o bien se aísla Candida spp. repetidamente, la mayoría de los intensivistas deciden iniciar tratamiento antifúngico. Este tratamiento es similar para candidemias, candidiasis invasivas diseminada y peritonitis candidiásica.

Palabras clave:

Peritonitis candidiásica

Candida spp.

Candidiasis invasiva

Abstract

Candida spp. is a component of the endogenous flora of the digestive tract and can consequently form part of the etiology of almost any type of abdominal infection. Candida spp. is therefore frequently isolated in polymicrobial secondary peritonitis due to intestinal suture dehiscence. In these cases, there is no clear consensus on when Candida spp. isolation in peritoneal drainage fluid represents infection rather than colonization. The general recommendation is to interpret that there is infection when the sample containing the pathogen is intraoperative or has been obtained directly from the intraabdominal collection. When Candida spp. is cultured in samples from subsequently obtained drainage fluid, colonization is a possibility. However, when these cultures are accompanied by signs of sepsis, the patient shows severity criteria or Candida spp. is repeatedly isolated, most intensivists decide to begin antifungal therapy. This treatment is similar for candidemias, disseminated invasive candidiasis and Candida peritonitis.

Keywords:

Candida peritonitis

Candida spp.

Invasive candidiasis

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Bibliografía

[1.]

S. Blot, K. Vandewoude, J. De Waele.

Candida peritonitis.

Curr Opin Crit Care, 13 (2007), pp. 195-199

http://dx.doi.org/10.1097/MCC.0b013e328028fd92 | Medline

[2.]

W.E. Trick, S.K. Fridkin, J.R. Edwards, R.A. Hajjeh, R.P. Gaynes, the National Nosocomial Infections Surveillance System Hospitals.

Secular Trend of Hospital-Acquired Candidemia among Intensive Care Unit Patients in the United States during 1989–1999.

Clinical Infect Dis, 35 (2002), pp. 627-630

[3.]

S. Blot, J.J. De Waele.

Critical issues in the clinical management of complicated intra-abdominal infections.

Drugs, 65 (2005), pp. 1611-1620

Medline

[4.]

P. Sandven, H. Qvist, E. Skovlund, NORGA.S. Group, the Norwegian Yeast Study Group.

Significance of Candida recovered from intraoperative specimens in patients with intra-abdominal perforations.

Crit Care Med, 30 (2002), pp. 541-547

Medline

[5.]

R. Zaragoza, J. Pemán, M. Salavert.

Is the use of antifungal management advisable in critical patients with positive isolation of Candida spp. from intraabdominal clinical samples?.

Rev Iberoam Micol, 25 (2008), pp. 203-207

Medline

[6.]

P. Montravers, H. Dupont, R. Gauzit, B. Veber, C. Auboyer, P. Blin.

Candida as a risk factor for mortality in peritonitis.

Crit Care Med, 34 (2006), pp. 646-652

http://dx.doi.org/10.1097/01.CCM.0000201889.39443.D2 | Medline

[7.]

H. Dupont, C. Paugam-Burtz, C. Muller-Serieys, L. Fierobe, D. Chosidow, J.P. Marmuse, et al.

Predictive factors of mortality due to polymicrobial peritonitis with Candida isolation in peritoneal fluid in critically ill patients.

Arch Surg, 137 (2002), pp. 1341-1346

Medline

[8.]

S.B. Wey, M. Mori, M.A. Pfaller, R.F. Woolson, R.P. Wenzel.

Hospital-acquired candidemia. The attributable mortality and excess length of stay.

Arch Intern Med, 148 (1988), pp. 2642-2645

[9.]

O. Gudlaugsson, S. Gillespie, K. Lee, B.J. Vande, J. Hu, S. Messer, et al.

Attributable mortality of nosocomial candidemia, revisited.

Clin Infect Dis, 37 (2003), pp. 1172-1177

[10.]

S.I. Blot, K.H. Vandewoude, E.A. Hoste, F.A. Colardyn.

Effects of nosocomial candidemia on outcomes of critically ill patients.

Am J Med, 113 (2002), pp. 480-485

Medline

[11.]

J. Morgan, M.I. Meltzer, B.D. Plikaytis, A.N. Sofair, S. Huie-White, S. Wilcox, et al.

Excess mortality, hospital stay, and cost due to candidemia: a case-control study using data from population-based candidemia surveillance.

Infect Control Hosp Epidemiol, 26 (2005), pp. 540-547

http://dx.doi.org/10.1086/502581 | Medline

[12.]

T.E. Zaoutis, J. Argon, J. Chu, J.A. Berlin, T.J. Walsh, C. Feudtner.

The epidemiology and attributable outcomes of candidemia in adults and children hospitalized in the United States: a propensity analysis.

Clin Infect Dis, 41 (2005), pp. 1232-1239

http://dx.doi.org/10.1086/496922 | Medline

[13.]

J. Nolla-Salas, A. Sitges-Serra, C. León-Gil, J. Martínez-González, M.A. León-Regidor, P. Ibáñez-Lucía, et al.

Candidemia in non-neutropenic critically ill patients: analysis of prognostic factors and assessment of systemic antifungal Therapy. Study Group of Fungal Infection in the ICU.

Intensive Care Med, 23 (1997), pp. 23-30

Medline

[14.]

C. León, F. Álvarez-Lerma, S. Ruiz-Santana, M.A. León, J. Nolla, R. Jordá, the EPCAN Study Group.

Fungal colonization and/or infection in non-neutropenic critically ill patients: results of the EPCAN observational study.

Eur J Clin Microbiol Infect Dis, 28 (2009), pp. 233-242

[15.]

J. Ibáñez-Nolla, M. Nolla-Salas, M.A. León, F. García, J. Marrugat, G. Soria, et al.

Early diagnosis of candidiasis in non-neutropenic critically ill patients.

J Infect, 48 (2004), pp. 181-192

Medline

[16.]

I. Gadea, M. Cuenca-Estrella.

Recomendaciones para el diagnóstico micológico y estudios de sensibilidad a los antifúngicos.

Enferm Infecc Microbiol Clin, 22 (2004), pp. 32-39

Medline

[17.]

B.D. Alexander, E.D. Ashley, L.B. Reller, S.D. Reed.

Cost savings with implementation of PNA FISH testing for identi fication of Candida albicans in blood cultures.

Diagn Microbiol Infect Dis, 54 (2006), pp. 277-282

http://dx.doi.org/10.1016/j.diagmicrobio.2005.10.011 | Medline

[18.]

M. Cuenca-Estrella, E. Martín Mazuelos, F. Álvarez-Lerma, C. Ortiz Leyba, C. León Gil.

Infecciones por Candida spp. en el paciente crítico.

Med Intensiva, Supl 3 (2005), pp. 12-20

[19.]

L. Ostrosky-Zeichner, B.D. Alexander, D.H. Kett, J. Vázquez, P.G. Pappas, F. Saeki, et al.

Multicenter clinical evaluation of the (1→3) beta-D-glucan assay as an aid to diagnosis of fungal infections in humans.

Clin Infect Dis, 41 (2005), pp. 654-659

http://dx.doi.org/10.1086/432470 | Medline

[20.]

L. Klingspor, S. Jalal.

Molecular detection and identification of Candida and Aspergillus spp. from clinical samples using real-time PCR.

Clin Microbiol Infect, 12 (2006), pp. 745-753

http://dx.doi.org/10.1111/j.1469-0691.2006.01498.x | Medline

[21.]

J. Montón.

El diagnóstico microbiológico independiente del cultivo en la candidiasis invasora. Importancia de los marcadores fúngicos.

Rev Iberoam Micol, 23 (2006), pp. 20-25

Medline

[22.]

J.R. Iruretagoyena, P. Regúlez, G. Quindos, J. Pontón.

Anticuerpos anti-micelio de Candida albicans en dos pacientes de cuidados intensivos con candidiasis invasora.

Rev Iberoam Micol, 23 (2006), pp. 50-53

Medline

[23.]

P.J. Eubanks, C. Virgilio, S. Klein, F. Bongard.

Candida sepsis in surgical patients.

Am J Surg, 166 (1993), pp. 617-619

Medline

[24.]

L. Puzniak, S. Teutsch, W. Powderly, L. Polish.

Has the epidemiology of nosocomial candidemia changed?.

Infect Control Hosp Epidemiol, 25 (2004), pp. 628

http://dx.doi.org/10.1086/502452 | Medline

[25.]

H. Dupont, A. Bourichon, C. Paugam-Burtz, J. Mantz, J.M. Desmonts.

Can yeast isolation in peritoneal fluid be predicted in intensive care unit patients with peritonitis?.

Crit Care Med, 31 (2003), pp. 752-757

http://dx.doi.org/10.1097/01.CCM.0000053525.49267.77 | Medline

[26.]

P. Montravers, H. Dupont, R. Gauzit, B. Veber, C. Auboyer, P. Blin.

Candida as a risk factor for mortality in peritonitis.

Crit Care Med, 34 (2006), pp. 646-652

http://dx.doi.org/10.1097/01.CCM.0000201889.39443.D2 | Medline

[27.]

D. Pittet, M. Monod, P.M. Suter, E. Frenk, R. Auckenthaler.

Candida colonization and subsequent infections in criti cally ill surgical patients.

Ann Surg, 220 (1994), pp. 751-758

[28.]

P. Pappas, C. Kauffman, D. Andes, D. Benjamin, T. Calandra, J. Edwards, et al.

Clinical practice guidelines for the management of Candidiasis: 2009 update by the Infectious Diseases Society of America.

CID, 48 (2009), pp. 503-535

[29.]

L. Senn, P. Eggimann, R. Ksontini, A. Pascual, N. Demartines, J. Bille, et al.

Caspofungin for prevention of intraabdominal candidiasis in high-risk surgical patients.

Intensive Care Med, 35 (2009), pp. 903-908

http://dx.doi.org/10.1007/s00134-009-1405-8 | Medline

[30.]

M. Cruciani, F. De Lalla, C. Mengoli.

Prophylaxis of Candida infections in adult trauma and surgical intensive care patients: a systematic review and meta-analysis.

Intens Care Med, 31 (2005), pp. 1479-1487

[31.]

P. Eggimann, P. Francioli, J. Bille, R. Schneider, M.M. Wu, G. Chapuis.

Fluconazole prophylaxis prevents intra-abdominal candidiasis in high risk surgical patients.

Crit Care Med, 27 (1999), pp. 1066-1072

Medline

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