Risk factors in surgical patients with intra-abdominal Candida infection in intensive care

Background Candida species have been isolated with increasing frequency during intra-abdominal infection, yet their role as pathogens or co-pathogens and as determinants for outcome, especially in patients who are frequently reoperated on, is not well understood. Furthermore, the value of antimycotic therapy is the subject of discussion. Methods Candida cultures from the abdomen of surgical patients over the past 10 years (1989–1999) were documented. Medical records of the patients were reviewed for risk factors for morbidity and death. Results Some 72 patients (45 men, 27 women), of mean age 60 (range 18–88) years, had Candida cultured from the abdomen during operation. Indications for surgery included duodenal ulcer perforation in 15 patients (21 per cent), gastrointestinal malignancy in 15 (21 per cent), pancreatitis in nine (12 per cent) and various disorders in the remaining 33. A total of 361 relaparotomies was performed in 72 patients (mean 5, range 0–48). Cultures were positive at the first laparotomy in 19 patients, at the first relaparotomy in 20 patients and in 33 patients at the second or more relaparotomy. All but one patient were treated in the intensive care unit. Some 45 (62 per cent) of 72 patients died a mean of 44 (range 3–234) days after the first laparotomy. Risk factors for death, which appeared not to be significant, are shown in the Table.   Died (n = 45) Survived (n = 27) * Values are mean (range) † values in parentheses are percentages. ‡ Daily ‘open’ abdomen wound lavage is counted as relaparotomy. § From identification of positive culture. AMT, antimycotic treatment No. of relaparotomies*‡ 5·3 (0–48) 4·5 (0–35) No. of co-morbid factors* 1·7 (0–4) 1·4 (0–4) Positive blood culture for Candida† 7 (16) 3 (11) Patients treated with AMT† 35 (78) 14 (52) Time to start of AMT (days)*§ 3·8 (0–18) 7·9 (0–21) Grade of infection* 2·2 (0·5–4) 1·7 (0·5–4) No. of bacterial types in abdominal cultures* 3·4 (0–8) 3·4 (0–8) Renal failure† 16 (36) 7 (26) Conclusion The number of relaparotomies among patients with Candida-positive cultures was high. No significant risk factors for death could be identified in surgical patients with intra-abdominal Candida infection in intensive care. © 2000 British Journal of Surgery Society Ltd