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

      research-article
      1 , 2 , 1 , 2 , , 1 , 2 , 3 , 4 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 1 , 2 , 15 , 15 , 16 , 17 , 50 , 18 , 19 , 20 , 21 , 22 , 52 , 53 , 54 , 23 , 24 , 25 , 49 , 26 , 27 , 28 , 29 , 15 , 30 , 31 , 32 , 33 , 2 , 34 , 17 , 35 , 36 , 51 , 24 , 37 , 38 , 39 , 40 , 2 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , from the Study Group for Infections in Critically Ill Patients (ESGCIP) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID)
      Infectious Diseases and Therapy
      Springer Healthcare
      Candida, Intra-abdominal infection, Invasive candidiasis, Risk factors

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          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.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s40121-021-00585-6.

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          Most cited references40

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          Validation of a combined comorbidity index

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            Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America.

            It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
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              International study of the prevalence and outcomes of infection in intensive care units.

              Infection is a major cause of morbidity and mortality in intensive care units (ICUs) worldwide. However, relatively little information is available about the global epidemiology of such infections. To provide an up-to-date, international picture of the extent and patterns of infection in ICUs. The Extended Prevalence of Infection in Intensive Care (EPIC II) study, a 1-day, prospective, point prevalence study with follow-up conducted on May 8, 2007. Demographic, physiological, bacteriological, therapeutic, and outcome data were collected for 14,414 patients in 1265 participating ICUs from 75 countries on the study day. Analyses focused on the data from the 13,796 adult (>18 years) patients. On the day of the study, 7087 of 13,796 patients (51%) were considered infected; 9084 (71%) were receiving antibiotics. The infection was of respiratory origin in 4503 (64%), and microbiological culture results were positive in 4947 (70%) of the infected patients; 62% of the positive isolates were gram-negative organisms, 47% were gram-positive, and 19% were fungi. Patients who had longer ICU stays prior to the study day had higher rates of infection, especially infections due to resistant staphylococci, Acinetobacter, Pseudomonas species, and Candida species. The ICU mortality rate of infected patients was more than twice that of noninfected patients (25% [1688/6659] vs 11% [ 682/6352], respectively; P < .001), as was the hospital mortality rate (33% [2201/6659] vs 15% [ 942/6352], respectively; P < .001) (adjusted odds ratio for risk of hospital mortality, 1.51; 95% confidence interval, 1.36-1.68; P < .001). Infections are common in patients in contemporary ICUs, and risk of infection increases with duration of ICU stay. In this large cohort, infection was independently associated with an increased risk of hospital death.
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                Author and article information

                Contributors
                anton.vena@gmail.com
                Journal
                Infect Dis Ther
                Infect Dis Ther
                Infectious Diseases and Therapy
                Springer Healthcare (Cheshire )
                2193-8229
                2193-6382
                19 February 2022
                19 February 2022
                April 2022
                : 11
                : 2
                : 827-840
                Affiliations
                [1 ]GRID grid.410345.7, ISNI 0000 0004 1756 7871, Clinica Malattie Infettive. Ospedale Policlinico San Martino – IRCCS, ; L.go R. Benzi 10, 16132 Genoa, Italy
                [2 ]GRID grid.5606.5, ISNI 0000 0001 2151 3065, Department of Health Sciences, , University of Genoa, ; Genoa, Italy
                [3 ]A.Li.Sa. Liguria Health Authority, Genoa, Italy
                [4 ]GRID grid.410345.7, ISNI 0000 0004 1756 7871, Healthcare Planning Unit, , Ospedale Policlinico San Martino – IRCCS, ; Genoa, Italy
                [5 ]GRID grid.411075.6, ISNI 0000 0004 1760 4193, Department of Intensive Care Anesthesiology and Emercency Medicine, , Fondazione Policlinico Universitario Agostino Gemelli IRCCS, ; Rome, Italy
                [6 ]GRID grid.8142.f, ISNI 0000 0001 0941 3192, Istituto di Anestesiologia e Rianimazione, , Università Cattolica del Sacro Cuore, ; Milan, Italy
                [7 ]GRID grid.411798.2, ISNI 0000 0000 9100 9940, Clinical Microbiology and ATB Centre, Institute of Medical Biochemistry and Laboratory Diagnostics, , General University Hospital, ; Prague, Czech Republic
                [8 ]GRID grid.10979.36, ISNI 0000 0001 1245 3953, Department of Medical Microbiology, , Medical Faculty of Palackeho University, ; Olomouc, Czech Republic
                [9 ]GRID grid.415185.c, Medical Direction, , Santa Corona Hospital, ; ASL 2 Regional Health System of Liguria, Pietra Ligure, Italy
                [10 ]Attikon General University Hospital, Athens, Greece
                [11 ]GRID grid.411119.d, ISNI 0000 0000 8588 831X, Département d’Anesthésie-Réanimation, , CHU Bichat-Claude Bernard, HUPNVS, APHP, ; Paris, France
                [12 ]GRID grid.5611.3, ISNI 0000 0004 1763 1124, Department of Diagnostics and Public Health, Infectious Disease Unit, , University of Verona, ; Verona, Italy
                [13 ]GRID grid.417094.f, ISNI 0000 0000 8828 8678, Ospedale Civile SS. Giovanni e Paolo, ; Venice, Italy
                [14 ]First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy
                [15 ]GRID grid.411492.b, Infectious Diseases Clinic, , Santa Maria della Misericordia University Hospital of Udine, ASUFC, ; Udine, Italy
                [16 ]GRID grid.7605.4, ISNI 0000 0001 2336 6580, Department of Medical Sciences, Infectious Diseases, , University of Turin, ; Turin, Italy
                [17 ]GRID grid.10776.37, ISNI 0000 0004 1762 5517, Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), , University of Palermo, ; Palermo, Italy
                [18 ]GRID grid.5216.0, ISNI 0000 0001 2155 0800, Department of Critical Care, , University Hospital Attikon, Attikon Medical School, Νational and Kapodistrian University of Athens, ; Athens, Greece
                [19 ]GRID grid.5253.1, ISNI 0000 0001 0328 4908, Department of Anesthesiology and Intensive Care Medicine, , Heidelberg University Hospital, ; Heidelberg, Germany
                [20 ]Servicio de Cuidados Críticos y Urgencias, Hospital San Juan de Dios del Aljarafe, Bormujos, Seville Spain
                [21 ]GRID grid.413363.0, ISNI 0000 0004 1769 5275, Department of Anesthesia and Intensive Care, , University Hospital of Modena, ; Modena, Italy
                [22 ]GRID grid.6190.e, ISNI 0000 0000 8580 3777, University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, , Excellence Center for Medical Mycology (ECMM), ; Cologne, Germany
                [23 ]GRID grid.6292.f, ISNI 0000 0004 1757 1758, Infectious Diseases Unit, Department of Medical and Surgical Science, , S. Orsola-Malpighi Hospital, University of Bologna, ; Bologna, Italy
                [24 ]GRID grid.10417.33, ISNI 0000 0004 0444 9382, Radboud Umc Center for Infectious Diseases, , Radboud University Medical Center, ; Nijmegen, The Netherlands
                [25 ]GRID grid.410569.f, ISNI 0000 0004 0626 3338, Department of Laboratory Medicine and National Reference Centre for Mycosis, , University Hospitals of Leuven, ; Leuven, Belgium
                [26 ]GRID grid.411119.d, ISNI 0000 0000 8588 831X, APHP; Medical and Infectious Diseases ICU (MI2), Bichat Hospital, ; 75018 Paris, France
                [27 ]GRID grid.460062.6, ISNI 0000000459364044, Infectious Diseases Department, , Azienda Sanitaria Universitaria Integrata Di Trieste, ; Trieste, Italy
                [28 ]GRID grid.411326.3, ISNI 0000 0004 0626 3362, Department of Intensive Care Medicine, , University Hospital Brussels (UZB), ; 1090 Jette, Belgium
                [29 ]GRID grid.8767.e, ISNI 0000 0001 2290 8069, Faculty of Medicine and Pharmacy, , Vrije Unversiteit Brussel (VUB), ; 1090 Brussels, Belgium
                [30 ]C.H. Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
                [31 ]GRID grid.416409.e, ISNI 0000 0004 0617 8280, Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), , St. James’s Hospital, ; Dublin, Ireland
                [32 ]GRID grid.413448.e, ISNI 0000 0000 9314 1427, Centro de Investigación Biomedica En Red-Enfermedades Respiratorias, , Instituto de Salud Carlos III, ; Madrid, Spain
                [33 ]Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona - Institut d’Investigacions Biomèdiques August Pi I Sunyer - University of Barcelona, Barcelona, Spain
                [34 ]GRID grid.414556.7, ISNI 0000 0000 9375 4688, Department of Emergency and Intensive Care Medicine, , Centro Hospitalar Universitário São João, Faculdade de Medicina da Universidade Do Porto E Grupo de Infecção E Sépsis, ; Porto, Portugal
                [35 ]GRID grid.510483.b, Institute for Biomedical Research and Innovation (IRIB) - National Research Council (CNR), ; Palermo, Italy
                [36 ]GRID grid.5379.8, ISNI 0000000121662407, Faculty of Biology, Medicine and Health, Division of Evolution, Infection and Genomics, , University of Manchester, ; Manchester, UK
                [37 ]GRID grid.411326.3, ISNI 0000 0004 0626 3362, Universitair Ziekenhuis Brussel, VUB University, ; Brussels, Belgium
                [38 ]G. Gennimatas General Hospital of Thessaloniki, Thessaloniki, Greece
                [39 ]GRID grid.508487.6, ISNI 0000 0004 7885 7602, Université Paris Diderot/Hopital Bichat-Réanimation Medicale et Des Maladies Infectieuses, ; Paris, France
                [40 ]GRID grid.508487.6, ISNI 0000 0004 7885 7602, UMR 1137-IAME Team 5-DeSCID: Decision Sciences in Infectious Diseases, Control and Care, , Inserm/Univ Paris Diderot, Sorbonne Paris Cité, ; Paris, France
                [41 ]GRID grid.8142.f, ISNI 0000 0001 0941 3192, Institute of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS – Università Cattolica del Sacro Cuore, ; Rome, Italy
                [42 ]GRID grid.4494.d, ISNI 0000 0000 9558 4598, Department of Intensive Care, , University Medical Center Groningen, ; Groningen, the Netherlands
                [43 ]GRID grid.41724.34, ISNI 0000 0001 2296 5231, Pole Anesthésie-Réanimation-SAMU, Rouen University Hospital, ; Rouen, France
                [44 ]GRID grid.7841.a, Department of Public Health and Infectious Diseases, , Sapienza University of Rome, ; Rome, Italy
                [45 ]Service de Réanimation Et USC Médico-Chirurgicale, AP-HP, Hôpitaux Universitaires de L’Est Parisien, Pôle TVAR, Hôpital Tenon, Paris, France
                [46 ]Department of General Internal Medicine, Medical Intensive Care Unit, University Hospitals Leuven, Leuven, UK
                [47 ]GRID grid.418080.5, ISNI 0000 0001 2177 7052, Centre Hospitalier de Versailles, ; Versailles, France
                [48 ]GRID grid.508487.6, ISNI 0000 0004 7885 7602, Université de Paris, INSERM UMR 1152 – PHERE, ; Paris, France
                [49 ]GRID grid.5596.f, ISNI 0000 0001 0668 7884, Department of Microbiology and Immunology and Transplantation, , KU Leuven, ; Leuven, Belgium
                [50 ]GRID grid.412510.3, ISNI 0000 0004 1756 3088, Department of Anesthesia, Intensive Care and Emergency, , Policlinico Paolo Giaccone, ; Palermo, Italy
                [51 ]GRID grid.498924.a, ISNI 0000 0004 0430 9101, Department of Infectious Diseases, , Manchester University NHS Foundation Trust, ; Wythenshawe Hospital, Manchester, UK
                [52 ]GRID grid.452408.f, University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, , Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), ; Cologne, Germany
                [53 ]GRID grid.6190.e, ISNI 0000 0000 8580 3777, University of Cologne, Faculty of Medicine and University Hospital Cologne, , Clinical Trials Centre Cologne (ZKS Köln), ; Cologne, Germany
                [54 ]GRID grid.452463.2, German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, ; Cologne, Germany
                Article
                585
                10.1007/s40121-021-00585-6
                8960530
                35182353
                2e478ca1-ebb1-4378-add4-7849b637bd49
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 29 September 2021
                : 14 December 2021
                Categories
                Original Research
                Custom metadata
                © The Author(s) 2022

                candida,intra-abdominal infection,invasive candidiasis,risk factors

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