Description:
<jats:title>Summary</jats:title><jats:p>The regular colonisation of the oesophagus with a <jats:italic>Candida</jats:italic> species can, after oesophageal perforation, result in a contamination of the mediastinum and the pleura with a <jats:italic>Candida</jats:italic> species. A patient cohort of 80 patients with oesophageal perforation between 1986 and 2010 was analysed retrospectively. The most common sources with positive results for <jats:italic>Candida</jats:italic> were mediastinal biopsies and broncho‐alveolar secretions. <jats:italic>Candida</jats:italic> species were detected in 30% of the patients. The mortality rate was 41% in patients with positive microbiology results for <jats:italic>Candida</jats:italic>, whereas it was 23% in the remaining patient cohort. This difference did not reach statistical significance (<jats:italic>P</jats:italic> = 0.124). Mortality associated with oesophageal perforation was attributed mainly to septic complications, such as mediastinitis and severe pneumonia. During the study period we observed a shift towards non‐albicans species that were less susceptible or resistant to fluconazole. In selected patients with risk factors as immunosuppression, granulocytopenia and long‐term intensive‐care treatment together with the finding of <jats:italic>Candida</jats:italic>, an antimycotic therapy should be started. A surgical approach offers the possibility to obtain deep tissue biopsies. The antimycotic therapy should start with an echinocandin, as the resistance to fluconazole is growing and to cover non‐albicans <jats:italic>Candida</jats:italic> species, too.</jats:p>