Clinical Outcomes of Critically Ill Patients with Candida spp. Peritonitis: A Retrospective Cohort Study

Abstract

Introduction/objectives: Peritonitis resulting from Candida spp. is common among critically ill patients and has been associated with adverse clinical outcomes. This study aimed to determine the effects of isolates of Candida species in patients with peritonitis on in-hospital mortality, general hospital stay, and intensive care unit (ICU) stays. Methods: This retrospective cohort study was conducted in two highly complex hospitals in Bogotá, Colombia, specifically by reference to patients who were hospitalized in the ICU between 2016 and 2022 with a clinical and microbiological diagnosis of peritonitis. For the analysis conducted for this research, two groups were established: patients with isolates of Candida spp. in the peritoneum and patients who had at least one bacterial microorganism in the culture. Multivariate logistic regression models and counting models featuring different mortality outcomes, different lengths of stay in the ICU, and different lengths of stay in the hospital were generated to evaluate the effect of the presence of Candida spp. and to account for potentially confounding variables. Results: A total of 373 patients, including 83 with Candida spp. and 290 with a bacterial etiology, were identified. Among the former group of patients, the most frequently identified species were C. albicans (50, 60.2%), C. tropicalis (18, 21.7%), and C. glabrata (7, 8.4%), whereas among the latter group, E. coli (186, 48.5%), K. pneumoniae (110, 29.8%), and E. faecalis (63, 16.9%) were most frequent. The 30-day mortality rate among patients with peritonitis and Candida isolates was 36.1%, and the corresponding rate among patients in the bacterial peritonitis group was 31.4% (p = 0.071). After adjustments were made to account for covariates, no significant differences were observed in mortality at 30 days (OR 0.75, 95% CI 0.20-1.18), length of hospital stay (iRR 1.11, 95% CI 0.90-1.40), or length of stay in the ICU (iRR 1.11, 95% CI 0.39) with respect to patients with peritonitis without fungal isolates. The Simplified Acute Physiology Score (SAPS2) (OR 1.04, 95% CI 1.03-1.06), World Society of Emergency Surgery (WSES) score (OR 1.11, (1.03-1.19), previous use of antifungals (OR 2.33, 1.21-4.52), and connective tissue disease (OR 3.71, 95% CI 1.30-10.99) were associated with 30-day mortality. Conclusions: The isolation of Candida species in peritoneal fluid from critically ill patients with peritonitis was not significantly associated with in-hospital mortality, length of hospital stay, or length of ICU stay after adjustments were made to account for other variables.

Keywords: Candida albicans; candidiasis; cohort studies; critical care; peritonitis.

Figure 1

Flow diagram of the patients included in the study.

Figure 2

Thirty-day survival curves (Kaplan-Meier) of the peritoneal infection groups.