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. 2022 Apr;11(2):827-840.
doi: 10.1007/s40121-021-00585-6. Epub 2022 Feb 19.

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

Matteo Bassetti #  1   2 , Antonio Vena #  3   4 , Daniele R Giacobbe  1   2 , Cecilia Trucchi  5   6 , Filippo Ansaldi  5   6 , Massimo Antonelli  7   8 , Vaclava Adamkova  9   10 , Cristiano Alicino  11 , Maria-Panagiota Almyroudi  12 , Enora Atchade  13 , Anna M Azzini  14 , Pierluigi Brugnaro  15 , Novella Carannante  16 , Maddalena Peghin  17 , Marco Berruti  1   2 , Alessia Carnelutti  17 , Nadia Castaldo  17 , Silvia Corcione  18 , Andrea Cortegiani  19   20 , George Dimopoulos  21 , Simon Dubler  22 , José L García-Garmendia  23 , Massimo Girardis  24 , Oliver A Cornely  25   26   27   28 , Stefano Ianniruberto  29 , Bart Jan Kullberg  30 , Katrien Lagrou  31   32 , Clement Lebihan  33 , Roberto Luzzati  34 , Manu Malbrain  35   36 , Maria Merelli  17 , Ana J Marques  37 , Ignacio Martin-Loeches  38   39   40 , Alessio Mesini  2 , José-Artur Paiva  41 , Santi Maurizio Raineri  19   42 , Riina Rautemaa-Richardson  43   44 , Jeroen Schouten  30 , Herbert Spapen  45 , Polychronis Tasioudis  46 , Jean-François Timsit  47   48 , Valentino Tisa  2 , Mario Tumbarello  49 , Charlotte H S B Van den Berg  50 , Benoit Veber  51 , Mario Venditti  52 , Guillaume Voiriot  53 , Joost Wauters  54 , Nathalie Zappella  55 , Philippe Montravers  56 ; from the Study Group for Infections in Critically Ill Patients (ESGCIP) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID)
Affiliations

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

Matteo Bassetti et al. Infect Dis Ther. 2022 Apr.

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.

Keywords: Candida; Intra-abdominal infection; Invasive candidiasis; Risk factors.

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