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World Journal of Surgery

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Open Access 01-05-2020 | Candidiasis | Original Scientific Report

Appropriate Source Control and Antifungal Therapy are Associated with Improved Survival in Critically Ill Surgical Patients with Intra-abdominal Candidiasis

Authors: Ting Yan, Shuang-Ling Li, Hai-Li Ou, Sai-Nan Zhu, Lei Huang, Dong-Xin Wang

Published in: World Journal of Surgery | Issue 5/2020

Abstract

Background

Intra-abdominal candidiasis (IAC) is the predominant type of invasive candidiasis with high mortality in surgical intensive care patients. The purpose of this study was to investigate the impact of appropriate source control and antifungal therapy on the outcomes of critically ill surgical patients with IAC.

Methods

This was a retrospective single-center cohort study. Adult surgical patients who were admitted to the intensive care unit and diagnosed with IAC from January 1, 2003, to December 31, 2016, were enrolled. The patients’ data including risk factors of IAC, infection-related information, antifungal treatment and 30-day outcomes were collected. The primary endpoint was 30-day mortality. A COX proportional hazards model was used to analyze the association between appropriate treatment and 30-day survival.

Results

A total of 82 patients were included in the analysis. Of these, 45 (54.9%) were complicated with septic shock at IAC diagnosis. Types of IAC included peritonitis (61.0%), intra-abdominal abscesses (23.2%) and biliary tract infections (15.9%). Of the included patients, 53 (64.6%) received appropriate source control and 44 (53.7%) appropriate antifungal therapy. Compared with patients with neither of these treatments, appropriate source control (HR 0.08, 95% CI 0.02–0.30; P < 0.001), appropriate antifungal therapy (HR 0.14, 95% CI 0.04–0.55; P = 0.005), and a combination of these treatments (HR 0.02, 95% CI 0.00–0.08; P < 0.001) were associated with reduced risk of death within 30 days after IAC diagnosis.

Conclusion

For critically ill surgical patients with IAC, both appropriate source control and appropriate antifungal therapy were associated with reduced risk of 30-day mortality, and the protective effects of the two appropriate treatments were additive.

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Title: Appropriate Source Control and Antifungal Therapy are Associated with Improved Survival in Critically Ill Surgical Patients with Intra-abdominal Candidiasis
Authors: Ting Yan
Shuang-Ling Li
Hai-Li Ou
Sai-Nan Zhu
Lei Huang
Dong-Xin Wang
Publication date: 01-05-2020
Publisher: Springer International Publishing
Keywords: Candidiasis
Candidiasis
Peritonitis
Published in: World Journal of Surgery / Issue 5/2020
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-020-05380-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Appropriate Source Control and Antifungal Therapy are Associated with Improved Survival in Critically Ill Surgical Patients with Intra-abdominal Candidiasis

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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