Journal of Parenteral and Enteral Nutrition

 

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Journal of Parenteral and Enteral Nutrition, Vol. 32, No. 3, 285-287 (2008)
DOI: 10.1177/0148607108316190

Case Reports

Necrotizing Candida Infection After Percutaneous Endoscopic Gastrostomy: A Fatal and Rare Complication

Rainer Wirth, MD1, Jürgen Bauer, MD2 and Cornel Sieber, MD2

From the 1 Clinic for Internal Medicine and Geriatrics, St Marien-Hospital Borken, Borken, Germany, and2 Friedrich-Alexander-Universität Erlangen-Nuremberg, Clinic for Internal Medicine II, Nuremberg Hospital, Nuremberg, Germany. Rainer Wirth provided the case treatment and preparation of the article; Jürgen Bauer and Cornel Sieber provided the critical review.

Address correspondance to: Rainer Wirth, MD, Klinik für Innere Medizin—Geriatrie, St Marien-Hospital Borken, D-46322 Borken, Germany; e-mail: rainer.wirth{at}hospital-borken.de.

Gastrostomy site infections following percutaneous endoscopic gastrostomy (PEG) are the most common complication after PEG placement. Recent meta-analyses were able to show that PEG site infections can be reduced significantly with a systemic antimicrobial prophylaxis. This mostly cephalosporin- or penicillin-based prophylaxis does not cover fungal infections. Although Candida skin infections after PEG placement are rarely described, a mucosal colonization or infection of the upper GI tract with Candida species is very common, especially in severely ill patients such as those requiring artificial nutrition. The authors report a rare and lethal case of a necrotizing PEG site infection with Candida albicans in a patient with diabetes with multiple comorbidities, presenting like gas gangrene. In patients with probable immunodeficiency or visible candidiasis of the skin, oropharynx, or esophagus, a Candida infection should be considered in case of a gastrostomy site infection.

Key Words: Candida • elderly • infection • necrotizing • PEG • percutaneous endoscopic gastrostomy


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