International Wound Journal ISSN 1742-4801
LETTER TO THE EDITOR
Fungal surgical site infections Dear Editors, I have read with great interest the article authored by Rose A. Cooper et al. published in the International Wound Journal (December 2013, 10 Suppl.) regarding the epidemiological and microbiological aspects of surgical site infections (SSIs) in trauma and orthopaedic surgery. The review article could have explored and provided much more ample coverage to opportunistic fungi which are involved in SSIs. In our experiences garnered from over 2300 bedded tertiary care, Kasturba Hospital located in Manipal, Southern Karnataka state, and medical mycology laboratory settings, we encounter an incidence of fungal SSIs of 4/1000 admissions in intensive care unit settings. The common agents include Candida albicans, Candida tropicalis, Candida glabrata and Rhodotorula glutinis which are of endogenous in nature and moulds such as Aspergillus flavus, Fusarium solani, Lichtheimia corymbifera, Mucor racemosus, Cunnighamella spinosum from the environment. Some times, yeast is found to coinfect with bacterial agents. Although a major share of SSIs is due to bacteria, the role of Candida in SSIs cannot be underestimated as their presence as a skin commensal makes them easier for colonization in immunocompromised patients and increases the propensity to invade upon breach in integument barrier (1). Furthermore, it is important to mull over site-specific surgical infections such as gastrointestinal tract infections following the evidence of pathological findings of oesophageal candidiasis during endoscopic examination. The increasing long-term use of azoles has also led to selection and emergence of azole drug resistance in Candida, which pose yet another challenge in the management of SSIs.
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C. glabrata is haploid in nature and develops rapid resistance to azole by means of alterations in the C. glabrata ERG11 gene (CgERG11) which encodes the azoles target enzyme. Alternative therapy such as liposomal amphotericin B is found to be appropriate in such cases. Furthermore, C. albicans and non-albicans species of Candida has the ability to form biofilms and propensity to adhere to prosthetic devices (2). Nosocomial Infection National Surveillance Scheme or NINSS established by the Department of Health and Public Health Laboratory Service (PHLS) in 1997 has now been renamed as Surgical Site Infection Surveillance Service (SSISS). The scheme initially run by Health Protection Agency (HPA) is currently managed by Healthcare Associate infection and Antimicrobial Resistance Department of the Public Health England (3). Dr Peralam Y. Prakash, M.Sc., Ph.D. Kasturba Medical College Manipal University Karnataka, India [email protected] doi: 10.1111/iwj.12302 References 1. Demet K, Canan AA, Muhterem Y. Fungal agents as a cause of surgical wound infections: an overview of host factors. Wounds 2007;19:8. 2. Erna MK, Rabih OD. Candida infections of medical devices. Clin Microbiol Rev 2004;17:255–7. 3. Surgical Site Infection Surveillance Service. Protocol for the surveillance of surgical site infectionVersion 6. London: Public Health England, 2013.
© 2014 The Author International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd
LETTER TO THE EDITOR
Fungal surgical site infections Dear Editors, I have read with great interest the article authored by Rose A. Cooper et al. published in the International Wound Journal (December 2013, 10 Suppl.) regarding the epidemiological and microbiological aspects of surgical site infections (SSIs) in trauma and orthopaedic surgery. The review article could have explored and provided much more ample coverage to opportunistic fungi which are involved in SSIs. In our experiences garnered from over 2300 bedded tertiary care, Kasturba Hospital located in Manipal, Southern Karnataka state, and medical mycology laboratory settings, we encounter an incidence of fungal SSIs of 4/1000 admissions in intensive care unit settings. The common agents include Candida albicans, Candida tropicalis, Candida glabrata and Rhodotorula glutinis which are of endogenous in nature and moulds such as Aspergillus flavus, Fusarium solani, Lichtheimia corymbifera, Mucor racemosus, Cunnighamella spinosum from the environment. Some times, yeast is found to coinfect with bacterial agents. Although a major share of SSIs is due to bacteria, the role of Candida in SSIs cannot be underestimated as their presence as a skin commensal makes them easier for colonization in immunocompromised patients and increases the propensity to invade upon breach in integument barrier (1). Furthermore, it is important to mull over site-specific surgical infections such as gastrointestinal tract infections following the evidence of pathological findings of oesophageal candidiasis during endoscopic examination. The increasing long-term use of azoles has also led to selection and emergence of azole drug resistance in Candida, which pose yet another challenge in the management of SSIs.
428
C. glabrata is haploid in nature and develops rapid resistance to azole by means of alterations in the C. glabrata ERG11 gene (CgERG11) which encodes the azoles target enzyme. Alternative therapy such as liposomal amphotericin B is found to be appropriate in such cases. Furthermore, C. albicans and non-albicans species of Candida has the ability to form biofilms and propensity to adhere to prosthetic devices (2). Nosocomial Infection National Surveillance Scheme or NINSS established by the Department of Health and Public Health Laboratory Service (PHLS) in 1997 has now been renamed as Surgical Site Infection Surveillance Service (SSISS). The scheme initially run by Health Protection Agency (HPA) is currently managed by Healthcare Associate infection and Antimicrobial Resistance Department of the Public Health England (3). Dr Peralam Y. Prakash, M.Sc., Ph.D. Kasturba Medical College Manipal University Karnataka, India [email protected] doi: 10.1111/iwj.12302 References 1. Demet K, Canan AA, Muhterem Y. Fungal agents as a cause of surgical wound infections: an overview of host factors. Wounds 2007;19:8. 2. Erna MK, Rabih OD. Candida infections of medical devices. Clin Microbiol Rev 2004;17:255–7. 3. Surgical Site Infection Surveillance Service. Protocol for the surveillance of surgical site infectionVersion 6. London: Public Health England, 2013.
© 2014 The Author International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd
