Candidiasis peritoneal: prevalencia y factores de riesgo

Hernández, María José; Balaguer, J.; Armero, R.; Baldó, Joana; Gómez, Lorena G.; Solaz, C.

doi:10.1016/j.riam.2012.10.005

Cited by 1 publication

(1 citation statement)

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“…Interestingly, upper gastrointestinal tract perforation and per-operative cardiovascular failure were previously included in a predictive score for severe intra-abdominal infections in the ICU [ 4 ]. Another Spanish study reported these two risk factors in 74 Candida peritonitis patients [ 25 ]. The two other parameters in the latter study (female gender and ongoing antimicrobial therapy for more than 48 hours) were not significant in our study [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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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.

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Section: Discussionmentioning

confidence: 99%