Appropriate Source Control and Antifungal Therapy are Associated with Improved Survival in Critically Ill Surgical Patients with Intra‐abdominal Candidiasis

Yan, Ting; Li, Shuang-Ling; Ou, Haili; Zhu, Sai-Nan; Huang, Lei; Wang, Dong‐Xin

doi:10.1007/s00268-020-05380-x

Cited by 6 publications

(11 citation statements)

References 32 publications

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“…(5) abdominal drainage tube placed more than 24 hours prior; (6) the patient had been enrolled within the ICU admission; and (7) incomplete data collection.…”

Section: Design and Study Objectmentioning

confidence: 99%

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Detection of Candida DNA in peritoneal fluids by PCR assay optimizing the diagnosis and treatment for intra-abdominal candidiasis in high-risk ICU patients: A prospective cohort study

Xie

Shao

Wan

et al. 2022

Preprint

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Background: Intra-abdominal candidiasis (IAC) is the predominant type of invasive candidiasis with high mortality in critically ill surgical patients. The high mortality rate may be related to the difficulty of early diagnosis. This study aimed to investigate whether the polymerase chain reaction (PCR) assay for detecting Candida DNA in peritoneal fluids (PF) is useful in diagnosing and antifungal treatment of IAC in high-risk patients in the ICU. Methods: A prospective single-center cohort study of surgical patients at high risk for IAC was conducted in the ICU. PF was collected from the abdominal drainage tubes (within 24 h) or by percutaneous puncture. Direct PF smear microscopy, PF culture, blood culture, and serum (1-3)-β-D-glucan were performed in all patients. For Candida PCR assay, the ITS1/ITS4 primers that targeted the ITS1-5.8s-ITS2 regions were used for PCR, and sequencing analysis was used to identify the pathogen at the species level. IAC was defined according to the 2013 European consensus criteria. Results: Among 83 patients at high risk for IAC, the IAC criteria were present in 17 (20.5%). The sensitivity and specificity of the Candida PCR assay were 64.7% and 89.4%, respectively, and the area under the receiver operating characteristic curve was 0.77 (95% CI: 0.63–0.91). In this cohort, the positive predictive value and negative predictive value for Candida PCR assay were 90.8% (95% CI: 80.3%–96.2%) and 61.1% (95% CI: 36.1%–81.7%), respectively. Diagnostic consistency was moderate (kappa 0.529, P < 0.001) according to the 2013 European consensus criteria. Assuming that positive Candida PCR in PF was the diagnostic criterion of IAC, the incidence of IAC could increase from 20.5% to 28.9% (P < 0.001), and the proportion of antifungal initial target therapies could increase from 11.3% to 32.1% (P < 0.001). Conclusions: Detection of Candida DNA in PF using PCR can be considered a supplement to existing diagnostic tools. This may optimize the diagnosis and antifungal treatment of IAC in high-risk surgical patients in the ICU.Trial registration: The study protocol was registered in the China Clinical Trial Registration Center (CHiCTR190022695). Registered 22 April 2019 (retrospectively registered).

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“…(5) abdominal drainage tube placed more than 24 hours prior; (6) the patient had been enrolled within the ICU admission; and (7) incomplete data collection.…”

Section: Design and Study Objectmentioning

confidence: 99%

“…The high mortality rate may be related to the di culty in early diagnosis of IAC [5] . Early diagnosis leads to earlier antifungal therapy and therapeutic outcome improvement [6,7] . However, appropriate tools for the early diagnosis of IAC are still lacking.…”

Section: Introductionmentioning

confidence: 99%

Detection of Candida DNA in peritoneal fluids by PCR assay optimizing the diagnosis and treatment for intra-abdominal candidiasis in high-risk ICU patients: A prospective cohort study

Xie

Shao

Wan

et al. 2022

Preprint

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“…The high mortality rate may be associated with the difficulty in early diagnosis of IAC ( Pemán et al, 2017 ). Early diagnosis may lead to earlier antifungal therapy and therapeutic outcome improvement ( Lagunes et al, 2017 ; Yan et al, 2020 ). However, appropriate tools for the early diagnosis of IAC are still lacking in critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

Detection of Candida DNA in peritoneal fluids by PCR assay optimizing the diagnosis and treatment for intra-abdominal candidiasis in high-risk ICU patients: A prospective cohort study

Xie¹,

Shao

Wan

et al. 2023

Front. Microbiol.

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BackgroundIntra-abdominal candidiasis (IAC) is the predominant type of invasive candidiasis with high mortality in critically ill patients. This study aimed to investigate whether the polymerase chain reaction (PCR) assay for detecting Candida DNA in peritoneal fluids (PF) is useful in diagnosing and management of IAC in high-risk patients in intensive care unit (ICU).MethodsA prospective single-center cohort study of surgical patients at high risk for IAC was conducted in the ICU. PF was collected from the abdominal drainage tubes (within 24 h) or by percutaneous puncture. Direct PF smear microscopy, PF culture, blood culture, and serum (1–3)-β-D-glucan were performed in all patients. For Candida PCR assay, the ITS1/ITS4 primers that targeted the ITS1-5.8 s-ITS2 regions were used for PCR, and sequencing analysis was used to identify the pathogen at the species level. IAC was defined according to the 2013 European consensus criteria.ResultsAmong 83 patients at high risk for IAC, the IAC criteria were present in 17 (20.5%). The sensitivity and specificity of the Candida PCR assay were 64.7 and 89.4%, respectively, and the area under the receiver operating characteristic curve was 0.77 (95% CI: 0.63–0.91). In this cohort, the positive predictive value and negative predictive value were 90.8% (95% CI: 80.3–96.2%) and 61.1% (95% CI: 36.1–81.7%), respectively. Diagnostic consistency was moderate (kappa 0.529, p < 0.001) according to the 2013 European consensus criteria.ConclusionDetection of Candida DNA in PF using PCR can be considered an adjunct to existing routine diagnostic tools which may optimize the diagnosis and antifungal treatment of IAC in high-risk patients in the ICU.

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“…Especially major abdominal surgery or GIS perforation in which the GIS system is opened is a critical risk factor for the development of candidemia [ 2 ]. The mortality rate in candidiasis of intra-abdominal origin is approximately 30%, which is approximately 40% if the patient is in the intensive care unit (ICU), and this rate may increase to 60% in the presence of septic shock [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Should Preventive Antifungal Treatment Be Given to Patients With Abdominal Contamination in the Intensive Care Unit?

Önder¹,

Keski̇n²

2023

Cureus

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Background Intra-abdominal contamination is a critical risk factor for candidemia. Because of the high mortality of candidemia and delayed results of cultures, preventive antifungal (AF) treatment can be administered. Especially in the intensive care unit (ICU), it may be necessary to determine the preventive AF approach due to the poor clinical condition of the patients. However, this practice is not standard among clinicians, and it is controversial whether it is beneficial or not. This study aimed to evaluate the effects of different AF treatment approaches (prophylactic, empirical, and culture-directed) on mortality, development of candidemia, and length of hospital stay in these patients. The primary outcome of the study was mortality, and the secondary outcomes were the development of candidemia and length of hospital stay. Methodology This is a retrospective, single-center, cohort study. Adult patients who were hospitalized in the ICU with the diagnosis of intra-abdominal contamination between January 1, 2017, and December 31, 2020, were reviewed retrospectively from electronic hospital records and Infectious Diseases ICU patient follow-up forms. Age, gender, comorbid diseases, the reason for hospitalization, history of surgical operation, surgical procedure type, length of hospital stay, culture results of blood and intraoperative intra-abdominal samples (pus, peritoneal fluid, abscess), type of AF agents, and mortality status of the patients were recorded. Furthermore, white blood cell (WBC) count, platelet count, C-reactive protein (CRP) level, procalcitonin (PCT) level, and serum albumin levels in blood samples taken on three different days (the day of diagnosis, the day of operation, and the day of candidemia) were examined. The patients were grouped as without AF, receiving prophylactic AF, receiving empirical AF, and receiving culture-directed AF. Additionally, the study population was evaluated by dividing it into two groups, namely, those who developed candidemia and those who did not. The patients were evaluated regarding the development of candidemia, AF treatment approach, length of hospital stay, and mortality. Results A total of 196 patients were included in the study. Candidemia was determined in 31.6% of the patients. Candidemia was more common in patients with a history of previous surgery and presenting with acute abdominal pain than other causes. It was determined that 70% of the patients who developed candidemia had perforation, with the most common being colonic perforation. The hospital stay was longer in patients with candidemia than without candidemia (47.9 vs. 22.4 days; p < 0.001). When empirical and prophylactic AF recipients were compared, there was no difference in mortality and length of hospital stay. Prolongation of the time to empirical treatment after perforation/leak was associated with increased candidemia (p = 0.004). Furthermore, patients with a waiting time of ≥4.5 days until surgical operation were at a hig...

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Appropriate Source Control and Antifungal Therapy are Associated with Improved Survival in Critically Ill Surgical Patients with Intra‐abdominal Candidiasis

Cited by 6 publications

References 32 publications

Detection of Candida DNA in peritoneal fluids by PCR assay optimizing the diagnosis and treatment for intra-abdominal candidiasis in high-risk ICU patients: A prospective cohort study

Detection of Candida DNA in peritoneal fluids by PCR assay optimizing the diagnosis and treatment for intra-abdominal candidiasis in high-risk ICU patients: A prospective cohort study

Detection of Candida DNA in peritoneal fluids by PCR assay optimizing the diagnosis and treatment for intra-abdominal candidiasis in high-risk ICU patients: A prospective cohort study

Should Preventive Antifungal Treatment Be Given to Patients With Abdominal Contamination in the Intensive Care Unit?

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