A multicenter multinational study of abdominal candidiasis: epidemiology, outcomes and predictors of mortality

作者：Bassetti Matteo^*; Righi Elda; Ansaldi Filippo; Merelli Maria; Scarparo Claudio; Antonelli Massimo; Garnacho Montero Jose; Diaz Martin Ana; Palacios Garcia Inmaculada; Luzzati Roberto; Rosin Chiara; Lagunes Leonel; Rello Jordi; Almirante Benito; Scotton Pier Giorgio; Baldin Gianmaria; Dimopoulos George; Nucci Marcio; Munoz Patricia; Vena Antonio; Bouza Emilio; de Egea Viviana; Colombo Arnaldo Lopes; Tascini Carlo; Menichetti Francesco; Tagliaferri Enrico

来源：Intensive Care Medicine, 2015, 41(9): 1601-1610.

DOI：10.1007/s00134-015-3866-2

• Abdominal candidiasis
• Candida
• Antifungal therapy
• Source control
• Mortality
• Adequate treatment

Clinical data on patients with intra-abdominal candidiasis (IAC) is still scarce.
We collected data from 13 hospitals in Italy, Spain, Brazil, and Greece over a 3-year period (2011-2013) including patients from ICU, medical, and surgical wards.
A total of 481 patients were included in the study. Of these, 27 % were hospitalized in ICU. Mean age was 63 years and 57 % of patients were male. IAC mainly consisted of secondary peritonitis (41 %) and abdominal abscesses (30 %); 68 (14 %) cases were also candidemic and 331 (69 %) had concomitant bacterial infections. The most commonly isolated Candida species were C. albicans (n = 308 isolates, 64 %) and C. glabrata (n = 76, 16 %). Antifungal treatment included echinocandins (64 %), azoles (32 %), and amphotericin B (4 %). Septic shock was documented in 40.5 % of patients. Overall 30-day hospital mortality was 27 % with 38.9 % mortality in ICU. Multivariate logistic regression showed that age (OR 1.05, 95 % CI 1.03-1.07, P < 0.001), increments in 1-point APACHE II scores (OR 1.05, 95 % CI 1.01-1.08, P = 0.028), secondary peritonitis (OR 1.72, 95 % CI 1.02-2.89, P = 0.019), septic shock (OR 3.29, 95 % CI 1.88-5.86, P < 0.001), and absence of adequate abdominal source control (OR 3.35, 95 % CI 2.01-5.63, P < 0.001) were associated with mortality. In patients with septic shock, absence of source control correlated with mortality rates above 60 % irrespective of administration of an adequate antifungal therapy.
Low percentages of concomitant candidemia and high mortality rates are documented in IAC. In patients presenting with septic shock, source control is fundamental.

• 出版日期2015-9