Purpose: To assess risk factors for development of intra-abdominal candidiasis (IAC) among patients admitted to intensive care unit (ICU).
Materials: We performed a case-control study in 26 European ICUs during the period January 2015- December 2016 (EUCANDICU project). Patients ≥18 years-old who developed an episode of microbiologically documented IAC during their stay in the ICU (at least 48 hours 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 of their matched cases prior to IAC onset).
Results: During the study period, 101 case patients with a diagnosis of IAC were included in the study. C. albicans (58.4%) and C. glabrata (15.8%) were the most commonly isolated species. On univariate analysis, severe hepatic failure, receiving parenteral nutrition, surgical re-intervention, recurrent gastrointestinal perforation, anastomotic leakage, previous antibiotic therapy, higher median number of abdominal surgical interventions were associated with IAC development. On multivariate analysis, recurrent gastrointestinal perforation (OR 5.64; 95% 1.46-21.80, p=0.01), anastomotic leakage (OR 2.86; 95% 1.11-7.38, p=0.03) and previous antimicrobial therapy (OR 2.91; 95% 1.24-6.80, p=0.01) were independently associated with IAC.
Conclusions: Recurrent gastrointestinal perforation or anastomotic leakage and prior antibiotic therapy may help to identify critically ill patients with higher probability of developing IAC. Prospective clinical studies are needed to identify which patients will benefit from early antifungal treatment.