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Risk Factors for Intra-Abdominal Candidiasis in Intensive Care Units: Results from EUCANDICU Study
M. Bassetti, A. Vena, DR. Giacobbe, C. Trucchi, F. Ansaldi, M. Antonelli, V. Adamkova, C. Alicino, MP. Almyroudi, E. Atchade, AM. Azzini, P. Brugnaro, N. Carannante, M. Peghin, M. Berruti, A. Carnelutti, N. Castaldo, S. Corcione, A. Cortegiani,...
Jazyk angličtina Země Nový Zéland
Typ dokumentu časopisecké články
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- Publikační typ
- časopisecké články MeSH
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.
1st Division of Infectious Diseases Cotugno Hospital AORN dei Colli Naples Italy
A Li Sa Liguria Health Authority Genoa Italy
Attikon General University Hospital Athens Greece
C H Vila Nova de Gaia Espinho Vila Nova de Gaia Portugal
Centre Hospitalier de Versailles Versailles France
Clinica Malattie Infettive Ospedale Policlinico San Martino IRCCS L go R Benzi 10 16132 Genoa Italy
Département d'Anesthésie Réanimation CHU Bichat Claude Bernard HUPNVS APHP Paris France
Department of Anesthesia and Intensive Care University Hospital of Modena Modena Italy
Department of Anesthesia Intensive Care and Emergency Policlinico Paolo Giaccone Palermo Italy
Department of Health Sciences University of Genoa Genoa Italy
Department of Intensive Care Medicine University Hospital Brussels 1090 Jette Belgium
Department of Intensive Care University Medical Center Groningen Groningen the Netherlands
Department of Medical Microbiology Medical Faculty of Palackeho University Olomouc Czech Republic
Department of Medical Sciences Infectious Diseases University of Turin Turin Italy
Department of Microbiology and Immunology and Transplantation KU Leuven Leuven Belgium
Department of Public Health and Infectious Diseases Sapienza University of Rome Rome Italy
Department of Surgical Oncological and Oral Science University of Palermo Palermo Italy
Faculty of Medicine and Pharmacy Vrije Unversiteit Brussel 1090 Brussels Belgium
G Gennimatas General Hospital of Thessaloniki Thessaloniki Greece
German Centre for Infection Research Partner Site Bonn Cologne Cologne Germany
Healthcare Planning Unit Ospedale Policlinico San Martino IRCCS Genoa Italy
Infectious Diseases Department Azienda Sanitaria Universitaria Integrata Di Trieste Trieste Italy
Institute for Biomedical Research and Innovation Palermo Italy
Istituto di Anestesiologia e Rianimazione Università Cattolica del Sacro Cuore Milan Italy
Medical and Infectious Diseases ICU Bichat Hospital 75018 Paris France
Medical Direction Santa Corona Hospital ASL 2 Regional Health System of Liguria Pietra Ligure Italy
Ospedale Civile SS Giovanni e Paolo Venice Italy
Pole Anesthésie Réanimation SAMU Rouen University Hospital Rouen France
Universitair Ziekenhuis Brussel VUB University Brussels Belgium
Citace poskytuje Crossref.org
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- $a Bassetti, Matteo $u Clinica Malattie Infettive. Ospedale Policlinico San Martino - IRCCS, L.go R. Benzi 10, 16132, Genoa, Italy $u Department of Health Sciences, University of Genoa, Genoa, Italy
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- $a Risk Factors for Intra-Abdominal Candidiasis in Intensive Care Units: Results from EUCANDICU Study / $c M. Bassetti, A. Vena, DR. Giacobbe, C. Trucchi, F. Ansaldi, M. Antonelli, V. Adamkova, C. Alicino, MP. Almyroudi, E. Atchade, AM. Azzini, P. Brugnaro, N. Carannante, M. Peghin, M. Berruti, A. Carnelutti, N. Castaldo, S. Corcione, A. Cortegiani, G. Dimopoulos, S. Dubler, JL. García-Garmendia, M. Girardis, OA. Cornely, S. Ianniruberto, BJ. Kullberg, K. Lagrou, C. Lebihan, R. Luzzati, M. Malbrain, M. Merelli, AJ. Marques, I. Martin-Loeches, A. Mesini, JA. Paiva, SM. Raineri, R. Rautemaa-Richardson, J. Schouten, H. Spapen, P. Tasioudis, JF. Timsit, V. Tisa, M. Tumbarello, CHSB. Van den Berg, B. Veber, M. Venditti, G. Voiriot, J. Wauters, N. Zappella, P. Montravers, from the Study Group for Infections in Critically Ill Patients (ESGCIP) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID)
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- $a 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.
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