title: A multicenter multinational study of abdominal candidiasis: epidemiology, outcomes and predictors of mortality.
abstract: OBJECTIVE
  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.
authors.affiliation: Infectious Diseases Division, Santa Maria Misericordia University Hospital, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy, mattba@tin.it.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bassetti
authors.forename: Elda
authors.initials: E
authors.lastname: Righi
authors.forename: Filippo
authors.initials: F
authors.lastname: Ansaldi
authors.forename: Maria
authors.initials: M
authors.lastname: Merelli
authors.forename: Claudio
authors.initials: C
authors.lastname: Scarparo
authors.forename: Massimo
authors.initials: M
authors.lastname: Antonelli
authors.forename: Jose
authors.initials: J
authors.lastname: Garnacho-Montero
authors.forename: Ana
authors.initials: A
authors.lastname: Diaz-Martin
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Palacios-Garcia
authors.forename: Roberto
authors.initials: R
authors.lastname: Luzzati
authors.forename: Chiara
authors.initials: C
authors.lastname: Rosin
authors.forename: Leonel
authors.initials: L
authors.lastname: Lagunes
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.forename: Benito
authors.initials: B
authors.lastname: Almirante
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Scotton
authors.forename: Gianmaria
authors.initials: G
authors.lastname: Baldin
authors.forename: George
authors.initials: G
authors.lastname: Dimopoulos
authors.forename: Marcio
authors.initials: M
authors.lastname: Nucci
authors.forename: Patricia
authors.initials: P
authors.lastname: Munoz
authors.forename: Antonio
authors.initials: A
authors.lastname: Vena
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
authors.forename: Viviana
authors.initials: V
authors.lastname: de Egea
authors.forename: Arnaldo Lopes
authors.initials: AL
authors.lastname: Colombo
authors.forename: Carlo
authors.initials: C
authors.lastname: Tascini
authors.forename: Francesco
authors.initials: F
authors.lastname: Menichetti
authors.forename: Enrico
authors.initials: E
authors.lastname: Tagliaferri
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Brugnaro
authors.forename: Maurizio
authors.initials: M
authors.lastname: Sanguinetti
authors.forename: Alessio
authors.initials: A
authors.lastname: Mesini
authors.forename: Gabriele
authors.initials: G
authors.lastname: Sganga
authors.forename: Claudio
authors.initials: C
authors.lastname: Viscoli
authors.forename: Mario
authors.initials: M
authors.lastname: Tumbarello
mesh_terms: D000005:Abdomen; D001938:Brazil; D002177:Candidiasis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006115:Greece; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012772:Shock, Septic / Q000382:microbiology; D013030:Spain