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Intra-abdominal candidiasis: The importance of early source control and antifungal treatment

Vergidis, P and Clancy, CJ and Shields, RK and Park, SY and Wildfeuer, BN and Simmons, RL and Nguyen, MH (2016) Intra-abdominal candidiasis: The importance of early source control and antifungal treatment. PLoS ONE, 11 (4).

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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 multi-variable 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.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Vergidis, P
Clancy, CJcjc76@pitt.eduCJC76
Shields, RKrshieres@pitt.eduRSHIERES
Park, SYsyp8@pitt.eduSYP8
Wildfeuer, BN
Simmons, RLrls13@pitt.eduRLS13
Nguyen, MHmhn5@pitt.eduMHN5
ContributionContributors NameEmailPitt UsernameORCID
Date: 1 April 2016
Date Type: Publication
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Journal or Publication Title: PLoS ONE
Volume: 11
Number: 4
DOI or Unique Handle: 10.1371/journal.pone.0153247
Institution: University of Pittsburgh
Schools and Programs: School of Medicine > Infectious Diseases and Microbiology
School of Medicine > Medicine
School of Medicine > Surgery
Refereed: Yes
Date Deposited: 31 Aug 2016 17:32
Last Modified: 30 Mar 2021 13:56


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