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Implications of Polymicrobial Blood-Borne Infection

Donna Lynn Dyess, MD; R. Neal Garrison, MD; Donald E. Fry, MD

Arch Surg. 1985;120(3):345-348.

Abstract
• Eighty-three patients with 117 episodes of candidemia were reviewed to examine the clinically significant variables and the results of treatment for this problem. Mortality was 52%. Patients who had bacteremia either synchronously or metachronously in association with Candida species had poorer survival rates. Staphylococcal and enterococcal species were the most frequently associated bacteria. Patients with Candida parapsilosis had better survival rates than patients with other species. Portals of entry for fungemia were catheters, wounds, the urinary tract, and the peritoneal cavity, but were undefined in 54% of patients. Antifungal chemotherapy could not be identified as affecting the outcome in these patients. It is suggested that candidemia in most patients represents a failure of host defense, and that septicemia of either bacteria or fungi may arise from the gastrointestinal tract in critically ill, immunocompromised patients.

(Arch Surg 1985;120:345-348)

Author Affiliations
From the Departments of Surgery, Veterans Administration Medical Centers, Louisville (Drs Dyess and Garrison) and Cleveland (Dr Fry); University of Louisville (Drs Dyess and Garrison); and Case Western Reserve University, Cleveland (Dr Fry).

Footnotes
Accepted for publication Aug 29, 1984.

Read before the Eighth Annual Surgical Symposium of the Association of Veterans Administration Surgeons, Los Angeles, May 11, 1984.

Reprint requests to Surgical Service, Veterans Administration Medical Center, 10701 E Boulevard, Cleveland, OH 44106 (Dr Fry).

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