Prognostic factors for patients with culture-positive Candida infection undergoing abdominal surgery

Abstract

Background and purpose: Increased risk for fungal infections has been observed in high-risk surgical patients, but the prognostic factors and impact of antifungal agents in this patient population are uncertain, especially in patients undergoing abdominal operation. This study was performed to ascertain the prognostic factors for patients with culture-positive Candida spp. who have had abdominal surgery.

Methods: From 2003 through 2006, all adult patients with positive candidal culture from abdominal specimens (peritoneal fluid obtained during laparotomy or drain effluent, abscess, or bile) at China Medical University Hospital, Taichung, Taiwan, were included in this retrospective study. Patients' demographic data, prognostic factors, and 30-day mortality rate related to fungal infection were analyzed by reviewing the medical charts.

Results: Thirty nine patients were enrolled in the study. The overall mortality rate was 35.9%. Candida albicans was the most common isolate (82.5%). The major prognostic factors were number of surgical interventions, Gram-negative bacteremia, high Acute Physiology And Chronic Health Evaluation (APACHE) II score, corticosteroid use, and subsequent candidal infection (p < 0.05).

Conclusions: In patients with positive intra-abdominal candidal culture, greater numbers of surgical intervention, Gram-negative bacilli bacteremia, and high APACHE II score were the prognostic factors for mortality. Corticosteroid use might be a risk factor for subsequent candidal infection.