title: Intra-Abdominal Candidiasis: The Importance of Early Source Control and Antifungal Treatment.
abstract: Intra-abdominal candidiasis (IAC) is poorly understood compared to candidemia. We described the clinical characteristics, microbiology, treatment and outcomes of IAC, and identified risk factors for mortality. We performed a retrospective study of adults diagnosed with IAC at our center in 2012-2013. Risk factors for mortality were evaluated using multivariable logistic regression. We identified 163 patients with IAC, compared to 161 with candidemia. Types of IAC were intra-abdominal abscesses (55%), secondary peritonitis (33%), primary peritonitis (5%), infected pancreatic necrosis (5%), and cholecystitis/cholangitis (3%). Eighty-three percent and 66% of secondary peritonitis and abscesses, respectively, stemmed from gastrointestinal (GI) tract sources. C. albicans (56%) and C. glabrata (24%) were the most common species. Bacterial co-infections and candidemia occurred in 67% and 6% of patients, respectively. Seventy-two percent of patients underwent an early source control intervention (within 5 days) and 72% received early antifungal treatment. 100-day mortality was 28%, and highest with primary (88%) or secondary (40%) peritonitis. Younger age, abscesses and early source control were independent predictors of survival. Younger age, abscesses and early antifungal treatment were independently associated with survival for IAC stemming from GI tract sources. Infectious diseases (ID) consultations were obtained in only 48% of patients. Consulted patients were significantly more likely to receive antifungal treatment. IAC is a common disease associated with heterogeneous manifestations, which result in poor outcomes. All patients should undergo source control interventions and receive antifungal treatment promptly. It is important for the ID community to become more engaged in treating IAC.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
authors.forename: Pascalis
authors.initials: P
authors.lastname: Vergidis
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.|VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America.
authors.forename: Cornelius J
authors.initials: CJ
authors.lastname: Clancy
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
authors.forename: Ryan K
authors.initials: RK
authors.lastname: Shields
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
authors.forename: Seo Young
authors.initials: SY
authors.lastname: Park
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
authors.forename: Brett N
authors.initials: BN
authors.lastname: Wildfeuer
authors.affiliation: Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Simmons
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
authors.forename: M Hong
authors.initials: MH
authors.lastname: Nguyen
mesh_terms: D018784:Abdominal Abscess / Q000188:drug therapy / Q000382:microbiology; D034841:Abdominal Cavity / Q000382:microbiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D002176:Candida albicans / Q000187:drug effects; D041221:Candida glabrata / Q000187:drug effects; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology*; D060085:Coinfection / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D041981:Gastrointestinal Tract / Q000382:microbiology; D006801:Humans; D059413:Intraabdominal Infections / Q000188:drug therapy / Q000382:microbiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010538:Peritonitis / Q000188:drug therapy / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000935:Antifungal Agents