Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Purpose

Clinical data on patients with intra-abdominal candidiasis (IAC) is still scarce.

Methods

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.

Results

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.

Conclusions

Low percentages of concomitant candidemia and high mortality rates are documented in IAC. In patients presenting with septic shock, source control is fundamental.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

CLSI:

Clinical Laboratory Standards Institute

COPD:

Chronic obstructive pulmonary disease

CVC:

Central venous catheter

ESRD:

End stage renal diseases

GI:

Gastrointestinal

IAC:

Intra-abdominal candidiasis

ICU:

Intensive care unit

References

  1. Rebolledo M, Sarria JC (2013) Intra-abdominal fungal infections. Curr Opin Infect Dis 26(5):441–446

    PubMed  Google Scholar 

  2. Blot SI, Vandewoude KH, De Waele JJ (2007) Candida peritonitis. Curr Opin Crit Care 13:195–199

    Article  PubMed  Google Scholar 

  3. Carneiro HA, Mavrakis A, Mylonakis E (2011) Candida peritonitis: an update on the latest research and treatments. World J Surg 35:2650–2659

    Article  PubMed  Google Scholar 

  4. Dupont H, Paugam-Burtz C, Muller-Serieys C, Fierobe L, Chosidow D, Marmuse JP, Mantz J, Desmonts JM (2002) Predictive factors of mortality due to polymicrobial peritonitis with Candida isolation in peritoneal fluid in critically ill patients. Arch Surg 137:1341–1346

    Article  PubMed  Google Scholar 

  5. Montravers P, Dupont H, Gauzit R, Veber B, Auboyer C, Blin P, Hennequin C, Martin C (2006) Candida as a risk factor for mortality in peritonitis. Crit Care Med 34:646–652

    Article  PubMed  Google Scholar 

  6. Sandven P, Qvist H, Skovlund E, Giercksky KE, NORGAS Group, the Norwegian Yeast Study Group (2002) Significance of Candida recovered from intraoperative specimens in patients with intra-abdominal perforations. Crit Care Med 30:541–547

  7. Bassetti M, Marchetti M, Chakrabarti A, Colizza S, Garnacho-Montero J, Kett DH, Munoz P, Cristini F, Andoniadou A, Viale P et al (2013) A research agenda on the management of intra-abdominal candidiasis: results from a consensus of multinational experts. Intensive Care Med 39:2092–2106

    Article  PubMed  Google Scholar 

  8. de Ruiter J, Weel J, Manusama E, Kingma WP, van der Voort PH (2009) The epidemiology of intra-abdominal flora in critically ill patients with secondary and tertiary abdominal sepsis. Infection 37(6):522–527

    Article  PubMed  Google Scholar 

  9. Lee SC, Fung CP, Chen HY, Li CT, Jwo SC, Hung YB, See LC, Liao HC, Loke SS, Wang FL, Lee JC (2002) Candida peritonitis due to peptic ulcer perforation: incidence rate, risk factors, prognosis and susceptibility to fluconazole and amphotericin B. Diagn Microbiol Infect Dis 44(1):23–27

    Article  PubMed  Google Scholar 

  10. Montravers P, Mira JP, Gangneux JP, Leroy O, Lortholary O, AmarCand study group (2011) A multicentre study of antifungal strategies and outcome of Candida spp. peritonitis in intensive-care units. Clin Microbiol Infect 17:1061–1067

    Article  CAS  PubMed  Google Scholar 

  11. Shields RK, Nguyen MH, Press EG, Clancy CJ (2014) Abdominal candidiasis is a hidden reservoir of echinocandin resistance. Antimicrob Agents Chemother 58(12):7601–7605

    Article  PubMed Central  PubMed  Google Scholar 

  12. Pappas PG, Kauffman CA, Andes D, Benjamin DK Jr, Calandra TF, Edwards JE Jr, Filler SG, Fisher JF, Kullberg BJ, Ostrosky-Zeichner L et al (2009) Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 48:503–535

    Article  CAS  PubMed  Google Scholar 

  13. Cornely OA, Bassetti M, Calandra T, Garbino J, Kullberg BJ, Lortholary O, Meersseman W, Akova M, Arendrup MC, Arikan-Akdagli S et al (2012) ESCMID guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients. Clin Microb Infect 18(Suppl 7):19–37

    Article  CAS  Google Scholar 

  14. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup et al (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 39:165–228

    Article  CAS  PubMed  Google Scholar 

  15. Montravers P, Dupont H, Eggimann P (2013) Intra-abdominal candidiasis: the guidelines-forgotten non-candidemic invasive candidiasis. Intensive Care Med 39:2226–2230

    Article  PubMed  Google Scholar 

  16. Messer SA, Moet GJ, Kirvy JT, Jones RN (2009) Activity of contemporary antifungal agents, including the novel echinocandin anidulafungin, tested against Candida spp., Cryptococcus spp., and Aspergillus spp.: report from the SENTRY antimicrobial surveillance program (2006–2007). J Clin Microbiol 47:1942–1946

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Bassetti M, Merelli M, Righi E, Diaz-Martin A, Rosello EM, Luzzati R, Parra A, Trecarichi EM, Sanguinetti M, Posteraro B et al (2013) Epidemiology, species distribution, antifungal susceptibility, and outcome of candidemia across five sites in Italy and Spain. J Clin Microbiol 51(12):4167–4172

    Article  PubMed Central  PubMed  Google Scholar 

  18. Maubon D, Garnaud C, Calandra T, Sanglard D, Cornet M (2014) Resistance of Candida spp. to antifungal drugs in the ICU: where are we now? Intensive Care Med 40:1241–1255

    Article  CAS  PubMed  Google Scholar 

  19. Delaloye J, Calandra T (2014) Invasive candidiasis as a cause of sepsis in the critically ill patient. Virulence 5:161–169

    Article  PubMed Central  PubMed  Google Scholar 

  20. Bassetti M, Righi E, Ansaldi F, Merelli M, Trucchi C, De Pascale G, Diaz-Martin A, Luzzati R, Rosin C, Lagunes L et al (2014) A multicenter study of septic shock due to candidemia: outcomes and predictors of mortality. Intensive Care Med 40:839–845

    Article  CAS  PubMed  Google Scholar 

  21. Guzman JA, Tchokonte R, Sobel JD (2011) Septic shock due to candidemia: outcomes and predictors of shock development. J Clin Med Res 3:65–71

    PubMed Central  CAS  PubMed  Google Scholar 

  22. Kollef M, Micek S, Hampton N, Doherty JA, Kumar A (2012) Septic shock attributed to Candida infection: importance of empiric therapy and source control. Clin Infect Dis 54:1739–1746

    Article  CAS  PubMed  Google Scholar 

  23. Morrell M, Fraser VJ, Kollef MH (2005) Delaying the empiric treatment of Candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality. Antimicrob Agents Chemother 49:3640–3645

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Lortholary O, Renaudat C, Sitbon K, Madec Y, Denoeud-Ndam L, Wolff M, Fontanet A, Bretagne S, Dromer F (2014) French Mycosis Study Group: worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002–2010). Intensive Care Med 40:1303–1312

    Article  PubMed Central  PubMed  Google Scholar 

  25. Garey KW, Rege M, Pai MP, Mingo DE, Suda KJ, Turpin RS, Bearden DT (2006) Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study. Clin Infect Dis 43:25–31

    Article  CAS  PubMed  Google Scholar 

  26. Patel GP, Simon D, Scheetz M, Crank CW, Lodise T, Patel N (2009) The effect of time to antifungal therapy on mortality in Candidemia associated septic shock. Am J Terapeutics 16:508–511

    Article  Google Scholar 

  27. Shan YS, Sy ED, Wang ST, Lee JC, Lin PW (2006) Early presumptive therapy with fluconazole for occult Candida infection after gastrointestinal surgery. World J Surg 30(1):119–126

    Article  PubMed  Google Scholar 

  28. Grim SA, Berger K, Teng C, Gupta S, Layden JE, Janda WM, Clark NM (2012) Timing of susceptibility-based antifungal drug administration in patients with Candida bloodstream infection: correlation with outcomes. J Antimicrob Chemother 67:707–714

    Article  CAS  PubMed  Google Scholar 

  29. Kludze-Forson M, Eschenauer GA, Kubin CJ, Della-Latta P, Lam SW (2010) The impact of delaying the initiation of appropriate antifungal treatment for Candida bloodstream infection. Med Mycol 48:436–439

    Article  CAS  PubMed  Google Scholar 

  30. Tumbarello M, Posteraro B, Trecarichi EM, Fiori B, Rossi M, Porta R, de Gaetano Donati K, La Sorda M, Spanu T, Fadda G et al (2007) Biofilm production by Candida species and inadequate antifungal therapy as predictors of mortality for patients with candidemia. J Clin Microbiol 45:1843–1850

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Research performed in collaboration with the Critically Ill Patients Study Group (CIPSG) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID).

Conflicts of interest

MB serves on scientific advisory boards for Pfizer Inc, Merck Serono, and Astellas Pharma Inc.; has received funding for travel or speaker honoraria from Pfizer Inc., Merck Serono, Gilead Sciences, Teva Inc, and Astellas Pharma Inc. ALC serves on scientific advisory boards for MSD and has received funding for continuing education programs from Pfizer Inc., Gilead Sciences, United Medical, MSD, and Astellas Pharma Inc. CT has been paid for lectures on behalf of Pfizer, Novartis, MSD, AstraZeneca, Zambon, and Astellas. Other authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Infectious Diseases Division, Santa Maria Misericordia University Hospital, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy

    Matteo Bassetti, Elda Righi, Maria Merelli & Claudio Scarparo

  2. IRCCS San Martino IST, Department of Health Sciences, University of Genoa, Genoa, Italy

    Filippo Ansaldi

  3. Care Department, Università Cattolica del Sacro Cuore, Rome, Italy

    Massimo Antonelli

  4. Critical Care and Emergency Clinical Unit, Virgen del Rocio University Hospital, Seville, Spain

    Jose Garnacho-Montero, Ana Diaz-Martin & Inmaculada Palacios-Garcia

  5. Infectious Diseases Unit, University Hospital of Trieste, Trieste, Italy

    Roberto Luzzati & Chiara Rosin

  6. Critical Care Department, Vall d’Hebron University Hospital, CIBERES, Universitat autonoma de Barcelona, Barcelona, Spain

    Leonel Lagunes, Jordi Rello & Benito Almirante

  7. Infectious Diseases Unit, Treviso Hospital, Treviso, Italy

    Pier Giorgio Scotton & Gianmaria Baldin

  8. Critical Care Department, Attikon University Hospital, Medical School, University of Athens, Athens, Greece

    George Dimopoulos

  9. Department of Internal Medicine, University Hospital, Federal University of Rio de Janeiro, Rio De Janeiro, Brazil

    Marcio Nucci

  10. Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain

    Patricia Munoz, Antonio Vena, Emilio Bouza & Viviana de Egea

  11. Hospital São Paulo, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil

    Arnaldo Lopes Colombo

  12. U.O. Malattie Infettive, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy

    Carlo Tascini, Francesco Menichetti & Enrico Tagliaferri

  13. Infectious Diseases Division, Venezia Hospital, Venice, Italy

    Pierluigi Brugnaro

  14. Institute of Microbiology, Università Cattolica del Sacro Cuore, Rome, Italy

    Maurizio Sanguinetti

  15. Infectious Diseases Division, San Martino Hospital, Genoa, Italy

    Alessio Mesini & Claudio Viscoli

  16. Division of General Surgery and Organ Transplantation, Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy

    Gabriele Sganga

  17. Institute of Infectious Diseases, Università Cattolica del Sacro Cuore, Rome, Italy

    Mario Tumbarello

Authors
  1. Matteo Bassetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elda Righi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Filippo Ansaldi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maria Merelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Claudio Scarparo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Massimo Antonelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jose Garnacho-Montero
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ana Diaz-Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Inmaculada Palacios-Garcia
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Roberto Luzzati
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Chiara Rosin
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Leonel Lagunes
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Jordi Rello
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Benito Almirante
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Pier Giorgio Scotton
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Gianmaria Baldin
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. George Dimopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Marcio Nucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Patricia Munoz
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Antonio Vena
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Emilio Bouza
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Viviana de Egea
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Arnaldo Lopes Colombo
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Carlo Tascini
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Francesco Menichetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. Enrico Tagliaferri
    View author publications

    You can also search for this author in PubMed Google Scholar

  27. Pierluigi Brugnaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  28. Maurizio Sanguinetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  29. Alessio Mesini
    View author publications

    You can also search for this author in PubMed Google Scholar

  30. Gabriele Sganga
    View author publications

    You can also search for this author in PubMed Google Scholar

  31. Claudio Viscoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  32. Mario Tumbarello
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matteo Bassetti.

Additional information

Collaborators

Marina Busetti, Montserrat Pujol, Joan Balcells, Tomas Pumarola, Maria Teresa Martin, Simone A. Nouér, Teresa Pelaez, Enzo Raise, Stefano Grandesso, Valerio Del Bono, Patricia Esteves, Cecilia Trucchi, Assunta Sartor, Gennaro De Pascale, Brunella Posteraro, Claudio Scarparo, Patricia Esteves.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bassetti, M., Righi, E., Ansaldi, F. et al. A multicenter multinational study of abdominal candidiasis: epidemiology, outcomes and predictors of mortality. Intensive Care Med 41, 1601–1610 (2015). https://doi.org/10.1007/s00134-015-3866-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-015-3866-2

Keywords

Search

Navigation