Prospective Evaluation of Perioperative Fungemia in Patients after Gastrointestinal Surgery

Seiji Haji, Makoto Usami, Akihiro Hirai, Kazuya Sakata, George Kotani, Atsunori Iso, Taichi Kanamaru, Hiroshi Kasahara, Masahiro Yamamoto, Yoichi Saitoh

First Department of Surgery, Kobe University School of Medicine

Fungemia in patients after gastrointestinal surgery was investigated. Twenty-two patients after major surgery including 6 with esophagectomy, 12 with total gastrectomy and 4 with pancreatectomy, were entered in the evaluation. Blood samples were collected before the operation and 2 and 10 days after the operation (POD). Candida antigenassay by the LA method (Cand-Tec test), β-D-glucan level by the Limulus test (the difference between Toxicolor and Endospecy test) and blood culture were performed. Both Cand-Tec and β-glucan levels at POD 2 were positive in 42.8% of the patients without obvious foci of fungal infection (p<0.01), suggesting microbial translocation. Blood culture of all samples were negative. Patients after esophagectomy showed high positive rates in Cand-Tec and β-D-glucan levels among the different operation methods without a significant difference. A Positive rate in the Cand-Tec test was associated with operative blood loss, increased white blood cell counts and poor nutritional state after the operation, indicating surgical stress and malnutriton as a cause of microbial translocation. It is concluded that transient microbial translocation occurs after gastrointestinal surgery.

Key words
perioperative fungemia, microbial translocation, gastrointestinal surgery, Cand-Tec, β-D-glucan

Reprint requests
Seiji Haji First Department of Surgery, Kobe University School of Medicine
7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650 JAPAN

Accepted
February 14, 1996

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