title: Association between source control and mortality in 258 patients with intra-abdominal candidiasis: a retrospective multi-centric analysis comparing intensive care versus surgical wards in Spain.
abstract: Early empiric therapy and adequate resuscitation have been identified as main predictors of outcome in patients with candidemia or bacteremia. Moreover, source control is a major determinant in infectious sites when feasible, as a main technique to reduce microbiological burden. A retrospective, multicenter, cohort study was performed at surgical wards and intensive care units (ICU) of three University Hospitals in Spain between 2010 and 2014, with the aim of improving understanding of the interaction between source control, early antifungal therapy, and use of vasoactives in patients with intra-abdominal candidiasis (IAC). Source control was defined as all physical actions taken to control a focus of infection and reduce the favorable conditions that promote microorganism growth or that maintain the impairment of host defenses. Two hundred and fifty-eight patients with IAC were identified. Sixty-one patients were at ICU for diagnosis. Mortality was higher in the ICU group compared to what was documented for the non-ICU group (35 % vs 19.5 %, p = 0011). Adequate source control within 48 h of diagnosis was achieved in 60 % of the cohort. In multivariate analysis, inadequate source control was identified as the only common risk factor for 30-day mortality in both groups (ICU group OR: 13.78 (95% CI: 2.60-72.9, p = 0.002) and non-ICU group OR: 6.53 (95% CI: 2.56-16.61, p = <0.001). The population receiving both adequate source control and adequate antifungal treatment was the one associated with a higher survival rate, in both the ICU and surgical groups. Source control remains a key element in IAC, inside and outside the intensive care unit. Early antifungal treatment among ICU patients was associated with lower mortality.
authors.affiliation: Critical Care Department, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119-129, 08035, Barcelona, Spain. leonel.lagunes@gmail.com.|Medicine Department, Universitat Autónoma de Barcelona, (UAB), Barcelona, Spain. leonel.lagunes@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Lagunes
authors.affiliation: Neurocritical and Burns Intensive Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Rey-Pérez
authors.affiliation: Microbiology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: M T
authors.initials: MT
authors.lastname: Martín-Gómez
authors.affiliation: Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Vena
authors.affiliation: Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: V
authors.initials: V
authors.lastname: de Egea
authors.affiliation: Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|Department of Medicine, Universidad Complutense (UCM), Madrid, Spain.|CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III (CIBERES), Madrid, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Muñoz
authors.affiliation: Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Bouza
authors.affiliation: Critical Care Department, Virgen Rocío University Hospital, Sevilla, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Díaz-Martín
authors.affiliation: Critical Care Department, Virgen Rocío University Hospital, Sevilla, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Palacios-García
authors.affiliation: Critical Care Department, Virgen Rocío University Hospital, Sevilla, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Garnacho-Montero
authors.affiliation: Preventive Medicine and Epidemiology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Campins
authors.affiliation: IAC Study Coordinator, Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bassetti
authors.affiliation: Medicine Department, Universitat Autónoma de Barcelona, (UAB), Barcelona, Spain.|CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III (CIBERES), Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Rello
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D002177:Candidiasis / Q000401:mortality* / Q000628:therapy*; D003422:Critical Care; D005260:Female; D006785:Hospitals, University; D006801:Humans; D059413:Intraabdominal Infections / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D064872:Patient Care Bundles / Q000379:methods*; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis