TY - JOUR
T1 - Candida infection and colonization among non-trauma emergency surgery patients
AU - Kourkoumpetis, Themistoklis
AU - Manolakaki, Dimitra
AU - Velmahos, George C.
AU - Chang, Yuchiao
AU - Alam, Hasan B.
AU - De Moya, Marc M.
AU - Sailhamer, Elizabeth A.
AU - Mylonakis, Eleftherios
N1 - Funding Information:
Research was supported by an unrestricted educational grant from Astellas Pharma US, Inc.
PY - 2010
Y1 - 2010
N2 - Background: Candida is a significant pathogen among critically ill patients. However, candidias is among non-trauma emergency surgery (NTES) patients has not been previously investigated. Herein we describe the incidence of both colonization and infection from Candida and risk factors for invasive disease in this population. Results: Of all 289 eligible patients, 63 (21.7%) fulfilled the criteria for Candida infection and 110 (38%) were included in the Candida colonization group. Interestingly, from the 63 patients with invasive candidiasis, 25 (39.7%) were infected by a non-albicans species. Upon multivariate analyses, ventilator-associated pneumonia (VAP) (Odds Ratio [OR]: 2.34; 95%,Confidence Interval [CI]: 1,213-4,533, p = 0.0112), bacteremia (OR: 4,778; 95% CI: 1,519-15,029, p = 0.0075) and surgical complications (OR: 3.903; 95% CI: 1,335-11,412, p = 0.0129) were independent risk factors for the development of Candida infection. Candida infection and colonization were both found to correlate with approximately $40,000-100,000 mean additional costs). Interestingly, candidemia was associated with 63% all-cause mortality. For all other forms of candidiasis, mortality was not significantly different among groups. Methods: For this retrospective single center study we included all NTES patients with ICU stay ≥4 days from May 1st, 2002 to April 30th, 2007. Patients were divided into 3 non-overlapping groups: (1) patients with Candida-infection, (2) patients with Candida colonization and (3) patients with negative Candida cultures. Groups were compared by univariate and multivariate analyses to identify significant risk factors for invasive candidiasis. Conclusion: We found that Candida infection is alarmingly high among NTES patients with prolonged intensive care unit (ICU) stay. Surgical complications and bacterial infections (VAP and bacteraemia) were significantly correlated with the development of candidiasis. Candidiasis reached a rate of 21.7/100 discharges, which is significantly higher than most established high-risk populations for candidiasis. Future studies should review the need for antifungal prophylaxis on this population.
AB - Background: Candida is a significant pathogen among critically ill patients. However, candidias is among non-trauma emergency surgery (NTES) patients has not been previously investigated. Herein we describe the incidence of both colonization and infection from Candida and risk factors for invasive disease in this population. Results: Of all 289 eligible patients, 63 (21.7%) fulfilled the criteria for Candida infection and 110 (38%) were included in the Candida colonization group. Interestingly, from the 63 patients with invasive candidiasis, 25 (39.7%) were infected by a non-albicans species. Upon multivariate analyses, ventilator-associated pneumonia (VAP) (Odds Ratio [OR]: 2.34; 95%,Confidence Interval [CI]: 1,213-4,533, p = 0.0112), bacteremia (OR: 4,778; 95% CI: 1,519-15,029, p = 0.0075) and surgical complications (OR: 3.903; 95% CI: 1,335-11,412, p = 0.0129) were independent risk factors for the development of Candida infection. Candida infection and colonization were both found to correlate with approximately $40,000-100,000 mean additional costs). Interestingly, candidemia was associated with 63% all-cause mortality. For all other forms of candidiasis, mortality was not significantly different among groups. Methods: For this retrospective single center study we included all NTES patients with ICU stay ≥4 days from May 1st, 2002 to April 30th, 2007. Patients were divided into 3 non-overlapping groups: (1) patients with Candida-infection, (2) patients with Candida colonization and (3) patients with negative Candida cultures. Groups were compared by univariate and multivariate analyses to identify significant risk factors for invasive candidiasis. Conclusion: We found that Candida infection is alarmingly high among NTES patients with prolonged intensive care unit (ICU) stay. Surgical complications and bacterial infections (VAP and bacteraemia) were significantly correlated with the development of candidiasis. Candidiasis reached a rate of 21.7/100 discharges, which is significantly higher than most established high-risk populations for candidiasis. Future studies should review the need for antifungal prophylaxis on this population.
KW - Candida
KW - Candidiasis
KW - Colonization
KW - Costs
KW - Emergency surgery
KW - Risk factors
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U2 - 10.4161/viru.1.5.12795
DO - 10.4161/viru.1.5.12795
M3 - Review article
AN - SCOPUS:78249273926
SN - 2150-5594
VL - 1
SP - 359
EP - 366
JO - Virulence
JF - Virulence
IS - 5
ER -