amphotericin-b and Peritoneal-Diseases

The recovery of Candida albicans along with bacteria from the abdomen in the setting of peritonitis is becoming increasingly common. It is not known whether the interactions between the fungal and bacterial elements of these infections are synergistic, competitive, or neutral. To study this question, we have examined the effects of both the addition of C. albicans to a solely bacterial infection caused by Escherichia coli and Bacteroides fragilis, and the deletion of various components of this system using directed antimicrobial therapy. In a mixed infection, both C. albicans and bacteria contributed to mortality, since only the combination of cefoxitin and amphotericin B improved survival (from 50% to 90%). The addition of C. albicans to the bacterial inoculum increased the recovery of abscesses, but only to the number seen with fungal infection alone, implying two fairly independent processes. Although the number of bacteria recovered from abscesses at 10 days postinfection was unchanged with the addition of fungi, the deletion of the bacterial component of mixed infections led to the overgrowth of C. albicans. We conclude that this model of mixed C. albicans/E. coli/B. fragilis peritonitis is best characterized as two nonsynergistic, parallel infections with incomplete competition, allowing the survival of all three organisms to eventual abscess formation.

Topics: Abscess; Amphotericin B; Animals; Bacteroides fragilis; Bacteroides Infections; Candida albicans; Candidiasis; Cefotetan; Cefoxitin; Clindamycin; Colony Count, Microbial; Drug Combinations; Escherichia coli; Escherichia coli Infections; Male; Mice; Mice, Inbred BALB C; Peritoneal Diseases; Peritonitis; Survival Rate

We reviewed the clinical courses of 63 surgical patients who had experienced one or more days of fungemia, to determine the clinical setting for such infections and to define indications for systemic therapy. Fifty-one patients experienced fungemia as a late complication of intraperitoneal infection. Candida was identified as part of a polymicrobial flora in 70%. If untreated, the mortality was 83% (30 of 36). No untreated patients with fungemia for more than one day survived. Adequate therapy with amphotericin B (total dose, greater than 3 mg/kg) improved survival to 67% (ten of 15). Autopsies performed in 20 cases revealed visceral Candida microabscesses in seven, with the gastrointestinal tract (12) and intraabdominal abscess (five) as the most common sources of fungi. These data support the concept of Candida as an important participant in polymicrobial infection and recommend therapy with amphotericin B for patients with intraperitoneal infection experiencing fungemia.

Topics: Abdomen; Abscess; Adolescent; Adult; Aged; Amphotericin B; Candidiasis; Child; Female; Gastrointestinal Diseases; Hospitalization; Humans; Male; Middle Aged; Peritoneal Diseases; Postoperative Complications; Retrospective Studies; Time Factors

Infection continues to be a major source of morbidity and the major source of mortality in renal transplant recipients who are susceptible to opportunistic infections. We recently reviewed all renal transplant recipients who had fungi cultured during a three year period. C. albicans and T. glabrata were cultured most frequently. Deep fungal infections occurred in many patients and were frequently observed late in the course of bacterial and viral infections. Ten patients had fungemia, and primary fungal pneumonia occurred in eight patients. Three patients had fungal infection of the central nervous system. Three of eight patients with fungal pneumonia and eight of ten patients with fungemia died as a result of their fungus infections. These patients frequently had poor renal function and were receiving high steroid doses or had recently been treated for kidney rejection. One patient with fungal pneumonia and six patients with fungemia had the fungus cultured from a superficial site. Several patients developed fungal infections late in the course of viral or bacterial infections. Amphotericin-B and 5-fluorocytosine remain the mainstays of antifungal therapy.

Topics: Adolescent; Adult; Amphotericin B; Central Nervous System Diseases; Female; Humans; Kidney Transplantation; Lung Diseases, Fungal; Male; Middle Aged; Mycoses; Peritoneal Diseases; Pneumonia; Postoperative Complications; Surgical Wound Infection; Transplantation, Homologous

Topics: Aminosalicylic Acids; Amphotericin B; Blastomycosis; Coitus; Endometritis; Epididymis; Fallopian Tubes; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Isoniazid; Lung; Male; Middle Aged; Peritoneal Diseases; Prostatic Diseases; Radiography; Sexually Transmitted Diseases; Testicular Diseases; Urogenital System; Urologic Diseases; Uterine Diseases