Risk factors for developing mucosal candidiasis of the upper gastrointestinal tract. The problem of antibiotic therapy

• Main Author: I.V. Kushnirenko
• Format: Article
• Language: English
• Published: Publishing House Zaslavsky 2019-04-01
• Series: Gastroenterologìa
• Subjects: candidiasis; mucous membrane; risk factors; antibiotic therapy; antifungal therapy
• Online Access: http://gastro.zaslavsky.com.ua/article/view/168979

Background. According to the literature, there are a number of factors causing the development of candidiasis of the upper digestive tract; however, their significance in the formation of the disease has not been fully determined. Controversial data exist regarding antibiotic therapy as a risk factor in patients who are not treated in the intensive care unit. There are no recommendations on the management of patients after the use of antibiotics. The purpose was to determine the risk factors for oropharyngeal candidiasis according to their contribution in the risk of developing the disease, as well as to study the problem of antibiotic therapy and to develop guidelines for the management of these patients. Materials and methods. Six hundred and thirty-eight patients were examined and surveyed, they were divided into groups according to the results of microbiological study of the tongue scraping: group 1 — 151 patients with oropharyngeal candidiasis, that is, ІV degree of colonization, group 2 — 327 persons with mild and moderate fungal growth (I, II and III degree of colonization), group 3 — 160 people with a negative result of seeding (degree 0). Results. Significant differences were found between groups 1 and 3 for such risk factors for oropharyngeal candidiasis as antibiotic therapy over a year, smoking, wearing dentures, the presence of vulvovaginal candidiasis in women, as well as concomitant thyroid disease and anemia. When comparing groups 1 and 2, taking antibiotics over a year and thyroid pathology are significant. The diagnostic sensitivity of the questionnaire formed on the basis of the obtained data is 83.3 %, confidence interval (CI) 75.9–88.8 %, specificity 75.1 %, CI 70.7–79.0 %, efficiency 77.0 %, CI 73.3–80.4 %. Of the 291 patients who were taking antibiotics, antifungal therapy was administered to 199 individuals (68.4 %), but the distribution of the degrees of fungal contamination did not differ between them. The analysis showed that the doses, the timing and the choice of the antifungal drug did not meet current international guidelines. Conclusions. The use of a diagnostic questionnaire developed with consideration of the risk factors for oropharyngeal candidiasis can increase the efficiency of diagnosis. Administration of antibiotic therapy requires observation of the patient and after microbiological verification of the diagnosis of candidiasis — treatment. The optimal therapeutic approach is the use of systemic antifungal drugs in accordance with international recommendations, with simultaneous correction of risk factors that can be modified.