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. 2020 Mar 9;10(1):4343.
doi: 10.1038/s41598-020-61113-z.

Yeast Infections After Esophagectomy: A Retrospective Analysis

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Free PMC article

Yeast Infections After Esophagectomy: A Retrospective Analysis

Marjolein Heuker et al. Sci Rep. .
Free PMC article

Abstract

Esophageal malignancy is a disease with poor prognosis. Curative therapy incorporates surgery and is burdensome with high rates of infection morbidity and mortality. The role of yeast as causative organisms of post-esophagectomy infections is poorly defined. Consequently, the benefits of specific antifungal prophylactic therapy in improving patient outcome are unclear. Therefore, this study aimed at investigating the incidence of yeast infections at the University Medical Center Groningen among 565 post-esophagectomy patients between 1991 and 2017. The results show that 7.3% of the patients developed a yeast infection after esophageal resection with significantly increased incidence among patients suffering from diabetes mellitus. For patients with yeast infections, higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, more frequent intensive care unit readmissions, prolonged hospital stays and higher mortality rates were observed. One-year survival was significantly lower for patients with a yeast infection, as well as diabetes mellitus and yeast-positive pleural effusion. We conclude that the incidence of yeast infections following esophagectomy is considerable, and that patients with diabetes mellitus are at increased risk. Furthermore, yeast infections are associated with higher complication rates and mortality. These observations encourage further prospective investigations on the possible benefits of antifungal prophylactic therapy for esophagectomy patients.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flowchart of the study design.
Figure 2
Figure 2
Possible causes and identification of yeast infections. The underlying cause of a yeast infection (A), causative species (B) and pleural drain cultures with and without yeast (C) are shown. In figure C, 3 patients with a yeast infection had a negative pleural drain culture but a positive culture from an alternate site and 3 patients who were defined as infection did not have a pleural drain culture sent for analysis and diagnosis was again made from an alternate site. *Candidemia was only detected in 2 patients. The source of both candidemia cases were unknown. **IV catheter infection without positive blood cultures.
Figure 3
Figure 3
Survival analysis of patients with or without yeast infection. Survival curves of (A) patients with yeast infection vs. non-yeast infection, (B) yeast infection vs. non-yeast infection in patients with diabetes mellitus, (C) patients with (poly)microbial drain culture + yeast vs. (poly)microbial drain cultures - yeast.

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