Introduction Intra-abdominal infections represent the second most frequently acquired infection in the intensive care unit (ICU), with mortality rates ranging from 20% to 50%. Candida spp. may be responsible for up to 10-30% of cases. This study assesses risk factors for development of intra-abdominal candidiasis (IAC) among patients admitted to ICU. Methods We performed a case-control study in 26 European ICUs during the period January 2015-December 2016. Patients at least 18 years old who developed an episode of microbiologically documented IAC during their stay in the ICU (at least 48 h after admission) served as the case cohort. The control group consisted of adult patients who did not develop episodes of IAC during ICU admission. Matching was performed at a ratio of 1:1 according to time at risk (i.e. controls had to have at least the same length of ICU stay as their matched cases prior to IAC onset), ICU ward and period of study. Results During the study period, 101 case patients with a diagnosis of IAC were included in the study. On univariate analysis, severe hepatic failure, prior receipt of antibiotics, prior receipt of parenteral nutrition, abdominal drain, prior bacterial infection, anastomotic leakage, recurrent gastrointestinal perforation, prior receipt of antifungal drugs and higher median number of abdominal surgical interventions were associated with IAC development. On multivariate analysis, recurrent gastrointestinal perforation (OR 13.90; 95% CI 2.65-72.82, p = 0.002), anastomotic leakage (OR 6.61; 95% CI 1.98-21.99, p = 0.002), abdominal drain (OR 6.58; 95% CI 1.73-25.06, p = 0.006), prior receipt of antifungal drugs (OR 4.26; 95% CI 1.04-17.46, p = 0.04) or antibiotics (OR 3.78; 95% CI 1.32-10.52, p = 0.01) were independently associated with IAC. Conclusions Gastrointestinal perforation, anastomotic leakage, abdominal drain and prior receipt of antifungals or antibiotics may help to identify critically ill patients with higher probability of developing IAC. Prospective studies are needed to identify which patients will benefit from early antifungal treatment.

Risk Factors for Intra-Abdominal Candidiasis in Intensive Care Units: Results from EUCANDICU Study

Antonelli, Massimo;Peghin, Maddalena;
2022-01-01

Abstract

Introduction Intra-abdominal infections represent the second most frequently acquired infection in the intensive care unit (ICU), with mortality rates ranging from 20% to 50%. Candida spp. may be responsible for up to 10-30% of cases. This study assesses risk factors for development of intra-abdominal candidiasis (IAC) among patients admitted to ICU. Methods We performed a case-control study in 26 European ICUs during the period January 2015-December 2016. Patients at least 18 years old who developed an episode of microbiologically documented IAC during their stay in the ICU (at least 48 h after admission) served as the case cohort. The control group consisted of adult patients who did not develop episodes of IAC during ICU admission. Matching was performed at a ratio of 1:1 according to time at risk (i.e. controls had to have at least the same length of ICU stay as their matched cases prior to IAC onset), ICU ward and period of study. Results During the study period, 101 case patients with a diagnosis of IAC were included in the study. On univariate analysis, severe hepatic failure, prior receipt of antibiotics, prior receipt of parenteral nutrition, abdominal drain, prior bacterial infection, anastomotic leakage, recurrent gastrointestinal perforation, prior receipt of antifungal drugs and higher median number of abdominal surgical interventions were associated with IAC development. On multivariate analysis, recurrent gastrointestinal perforation (OR 13.90; 95% CI 2.65-72.82, p = 0.002), anastomotic leakage (OR 6.61; 95% CI 1.98-21.99, p = 0.002), abdominal drain (OR 6.58; 95% CI 1.73-25.06, p = 0.006), prior receipt of antifungal drugs (OR 4.26; 95% CI 1.04-17.46, p = 0.04) or antibiotics (OR 3.78; 95% CI 1.32-10.52, p = 0.01) were independently associated with IAC. Conclusions Gastrointestinal perforation, anastomotic leakage, abdominal drain and prior receipt of antifungals or antibiotics may help to identify critically ill patients with higher probability of developing IAC. Prospective studies are needed to identify which patients will benefit from early antifungal treatment.
2022
2022
Candida; Intra-abdominal infection; Invasive candidiasis; Risk factors
Bassetti, Matteo; Vena, Antonio; Giacobbe, Daniele R; Trucchi, Cecilia; Ansaldi, Filippo; Antonelli, Massimo; Adamkova, Vaclava; Alicino, Cristiano; Almyroudi, Maria-Panagiota; Atchade, Enora; Azzini, Anna M; Brugnaro, Pierluigi; Carannante, Novella; Peghin, Maddalena; Berruti, Marco; Carnelutti, Alessia; Castaldo, Nadia; Corcione, Silvia; Cortegiani, Andrea; Dimopoulos, George; Dubler, Simon; García-Garmendia, José L; Girardis, Massimo; Cornely, Oliver A; Ianniruberto, Stefano; Kullberg, Bart Jan; Lagrou, Katrien; Lebihan, Clement; Luzzati, Roberto; Malbrain, Manu; Merelli, Maria; Marques, Ana J; Martin-Loeches, Ignacio; Mesini, Alessio; Paiva, José-Artur; Raineri, Santi Maurizio; Rautemaa-Richardson, Riina; Schouten, Jeroen; Spapen, Herbert; Tasioudis, Polychronis; Timsit, Jean-François; Tisa, Valentino; Tumbarello, Mario; Van den Berg, Charlotte H S B; Veber, Benoit; Venditti, Mario; Voiriot, Guillaume; Wauters, Joost; Zappella, Nathalie; Montravers, Philippe
File in questo prodotto:
File Dimensione Formato  
eucandicu_addome.pdf

accesso aperto

Tipologia: Versione Editoriale (PDF)
Licenza: Creative commons
Dimensione 317.81 kB
Formato Adobe PDF
317.81 kB Adobe PDF Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11383/2140699
Citazioni
  • ???jsp.display-item.citation.pmc??? 6
  • Scopus 12
  • ???jsp.display-item.citation.isi??? 11
social impact