Consideration of Antifungal Coverage in Treating Infections Related to Delayed Esophageal Perforation from Anterior Cervical Spine Hardware

(1) Background/Objectives: Delayed esophageal perforation following anterior cervical (spine) discectomy and fusion (ACDF) is rare but can lead to serious infectious complications. The treatment usually involves hardware explanation and prolonged intravenous antibiotics; however, there are scarce reports about the microbiology of these infections and corresponding targeted therapy. (2) Methods: Patients diagnosed or treated for delayed esophageal perforation after anterior cervical fusion between 2000-2020 at a tertiary medical center were studied. (3) Results: Seven patients with delayed esophageal perforation following ACDF were identified. The most common bacteria isolated included <i>Streptococcus</i>, <i>Haemophilus</i>, and <i>Mycobacterium</i> species. The cultures from five patients grew fungal species, including <i>Candida albicans</i> and <i>C. glabrata</i>. All the patients received several weeks of broad-spectrum antibiotics, and, notably, 5/7 patients received antifungal therapy targeting <i>Candida</i>. (4) Conclusions: Although the incidence of delayed esophageal perforation following ACDF is low, providers should remain aware of this entity due to the serious infectious complications. Most infections are polymicrobial in nature, and providers should consider empiric antifungal coverage specifically targeting <i>Candida</i> species when treating patients with this complication.