Mediastinitis: Could your case be a candidate for candida?

BACKGROUND: Candida mediastinitis is rare, but mortality has been reported as high as 50%. There are no clinical trials evaluating treatment of Candida mediastinitis and there are only a limited number of reports in the literature. CASE REPORT: We present two cases of mediastinitis after coronary artery bypass grafting due to Candida albicans. Immunosuppression and long surgical procedures were likely risk factors for the infections. After multiple hospitalizations and debridements there was concern for the development of resistance. However, the isolates were determined to be fluconazole-susceptible and the patients were treated with long-term oral fluconazole. CONCLUSIONS: Candida mediastinitis is difficult to treat. Even with appropriate treatment, patients may require numerous surgical debridements.