title: Can yeast isolation be predicted in complicated secondary non-postoperative intra-abdominal infections?
abstract: BACKGROUND
  The aim of this study was to create a predictive score for yeast isolation in patients with complicated non-postoperative intra-abdominal infections (CNPIAI) and to evaluate the impact of yeast isolation on outcome.
  
  
  METHODS
  All patients with a CNPIAI undergoing emergency surgery over a three-year period were included in the retrospective cohort (RC, n = 290). Patients with a yeast-positive peritoneal fluid culture (YP) were compared with patients with a yeast-negative culture (YN). Multivariate logistic regression was used to identify factors independently associated with yeast isolation and a predictive score was built. The score's performance was then established in the prospective cohort (PC, n = 152) over an 18-month period. Outcome of the whole cohort was evaluated and independent risks factors of mortality searched.
  
  
  RESULTS
  In the RC, 39 patients (13.4%) were YP. Four factors were independently associated with the YP group: length of stay before surgery ≥48 h (odds ratio (OR) (95% confidence interval (CI)) = 3.1 (1.4 to 6.9), P = 0.004, 1 point), per-operative cardiovascular failure (2.4 (1.1 to 5.8), P = 0.04, 1 point), generalized peritonitis (6.8 (2.7 to 16.7), P <0.001, 2 points) and upper gastrointestinal tract perforation (2.5 (1.2 to 5.6), P = 0.02, 1 point). In the PC, the area under the curve (95%CI) of the predictive score's receiver operating characteristic curve was 0.79 (0.72 to 0.86). For predicting an intra-abdominal candidiasis (IAC), a score ≥3 had a sensitivity of 0.60, a specificity of 0.84, a positive predictive value of 0.49 and a negative predictive value of 0.89. Furthermore, yeast isolation was associated with worse outcome and independently associated with mortality in the whole cohort (OR = 2.15; 95%CI (1.03 to 4.46), P = 0.04).
  
  
  CONCLUSIONS
  The new predictive score can be used to rule out intra-abdominal candidiasis and thus avoid the initiation of antifungal treatment. It is suited to less severe infections than previously published scores. IAC is associated independently with an increased mortality in this population.
authors: Hervé
authors: H
authors: Dupont
authors: Mathieu
authors: M
authors: Guilbart
authors: Alexandre
authors: A
authors: Ntouba
authors: Mélanie
authors: M
authors: Perquin
authors: Sandra
authors: S
authors: Petiot
authors: Jean-Marc
authors: JM
authors: Regimbeau
authors: Taieb
authors: T
authors: Chouaki
authors: Yazine
authors: Y
authors: Mahjoub
authors: Elie
authors: E
authors: Zogheib
mesh_terms: D000368:Aged; D001202:Ascitic Fluid / Q000382:microbiology*; D002177:Candidiasis / Q000175:diagnosis*; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D005658:Fungi / Q000302:isolation & purification*; D041981:Gastrointestinal Tract / Q000293:injuries; D006333:Heart Failure / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D059413:Intraabdominal Infections / Q000382:microbiology* / Q000401:mortality*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity