Can yeast isolation be predicted in complicated secondary non-postoperative intra-abdominal infections?

Abstract

IntroductionThe aim of this study was to create a predictive score for yeast isolation in patients with complicated non-postoperative intra-abdominal infections (CNPIAI) and to evaluate the impact of yeast isolation on outcome.MethodsAll patients with a CNPIAI undergoing emergency surgery over a three-year period were included in the retrospective cohort (RC, n = 290). Patients with a yeast-positive peritoneal fluid culture (YP) were compared with patients with a yeast-negative culture (YN). Multivariate logistic regression was used to identify factors independently associated with yeast isolation and a predictive score was built. The score’s performance was then established in the prospective cohort (PC, n = 152) over an 18-month period. Outcome of the whole cohort was evaluated and independent risks factors of mortality searched.ResultsIn the RC, 39 patients (13.4%) were YP. Four factors were independently associated with the YP group: length of stay before surgery ≥48 h (odds ratio (OR) (95% confidence interval (CI)) = 3.1 (1.4 to 6.9), P = 0.004, 1 point), per-operative cardiovascular failure (2.4 (1.1 to 5.8), P = 0.04, 1 point), generalized peritonitis (6.8 (2.7 to 16.7), P <0.001, 2 points) and upper gastrointestinal tract perforation (2.5 (1.2 to 5.6), P = 0.02, 1 point). In the PC, the area under the curve (95%CI) of the predictive score’s receiver operating characteristic curve was 0.79 (0.72 to 0.86). For predicting an intra-abdominal candidiasis (IAC), a score ≥3 had a sensitivity of 0.60, a specificity of 0.84, a positive predictive value of 0.49 and a negative predictive value of 0.89. Furthermore, yeast isolation was associated with worse outcome and independently associated with mortality in the whole cohort (OR = 2.15; 95%CI (1.03 to 4.46), P = 0.04).ConclusionsThe new predictive score can be used to rule out intra-abdominal candidiasis and thus avoid the initiation of antifungal treatment. It is suited to less severe infections than previously published scores. IAC is associated independently with an increased mortality in this population.

Critically ill patients with community-onset intraabdominal infections: Influence of healthcare exposure on resistance rates and mortality

“…In the present study, overall mortality was similar to the one described in other studies on non-post-operative intraabdominal infections [31,32]. The multivariate analysis did not identify AMR as variable associated with 30-day mortality.…”

Predictors of choice of initial antifungal treatment in intraabdominal candidiasis

“…The differentiation between contamination and infection when Candida is recovered from intraabdominal samples is currently under debate, but in any case the presence of this pathogen has been associated with poor prognosis [7,8]. Recently, an expert European consensus attempted to redefine IAC [9], and a subsequent report showed a high mortality associated with this condition [16].…”

“…Intraabdominal candidiasis (IAC) is the second most frequent form of invasive candidiasis after bloodstream infection, and it has been associated with high mortality rates of between 25% and 40% [2e6]. The recovery of Candida from the abdominal cavity has a worse prognosis in patients with peritonitis [7,8]. The clinical criteria for defining IAC are not specific, although a recent European consensus of experts shortened the definition of an IAC episode [9].…”

What every intensivist should know about the management of peritonitis in the intensive care unit

“…( 30 ) For the prediction of candida involvement in abdominal infections, Dupont et al developed a score that includes the length of stay before surgery, preoperative cardiovascular failure, generalized peritonitis, and upper gastrointestinal tract perforation as the relevant risk factors. ( 31 ) The usefulness of this model needs to be confirmed.…”