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Published in: World Journal of Surgery 9/2009

01-09-2009

Candida Isolation in Patients Hospitalized on a Surgical Ward: Significance and Mortality-Related Factors

Authors: J. Marchena-Gomez, T. Saez-Guzman, M. Hemmersbach-Miller, A. Conde-Martel, V. Morales-Leon, A. Bordes-Benitez, M. A. Acosta-Merida

Published in: World Journal of Surgery | Issue 9/2009

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Abstract

Background

Infections caused by Candida are an emerging pathology on surgical wards. The aim of the present study was to evaluate the incidence, characteristics, and predictive factors of mortality in patients colonized and/or infected by Candida spp. in this setting.

Methods

A consecutive series of 105 patients hospitalized on a general surgery ward between 2000 and 2004 were included, and 118 positive cultures for Candida were identified. The variables age, sex, previous medical history, current disease, anemia, ICU stay, type and localization of the microorganism, need for parenteral nutrition, and transfusions were recorded. The primary outcome was in-hospital mortality. A univariate analysis was performed to determine which of these variables were associated with mortality. With a logistic regression model, independent prognostic factors of mortality were determined.

Results

The prevalence of patients colonized and/or infected by Candida on our surgical ward was 0.98% (CI 95%: 0.79–1.17), and the incidence was 49 cases per 1,000 patient-years. Of the 105 patients in this series, 56 were men (53%) and 49 women (47%); the mean age was 63.8 years (SD ± 15.7). Twelve patients (11.4%) had candidemia. Crude mortality was 23% (24 patients), whereas the mortality attributable to candidemia was 25% (3/12 cases). Anemia (p = 0.001); transfusions (p = 0.003), and an ICU stay (p = 0.002) were associated with mortality. Candidemia was associated with neoplasms (p = 0.02) and the infection caused by Candida parapsilosis (p = 0.04). The only independent factor related to mortality was the anemia (p = 0.028; Odds Ratio: 6.43; 95% CI: 1.23–33.73).

Conclusions

Colonization and/or infection by Candida spp. in non-ICU hospitalized surgical patients implies a relative high mortality. Anemia is an independent factor for mortality.
Literature
1.
go back to reference Luzzati R, Amalfitano G, Lazzarini L et al (2000) Nosocomial candidemia in non-neutropenic patients at an Italian tertiary care hospital. Eur J Clin Microbiol Infect Dis 19:602–607PubMedCrossRef Luzzati R, Amalfitano G, Lazzarini L et al (2000) Nosocomial candidemia in non-neutropenic patients at an Italian tertiary care hospital. Eur J Clin Microbiol Infect Dis 19:602–607PubMedCrossRef
2.
go back to reference Leon C, Alvarez-Lerma F, Ruiz-Santana S et al (2009) Fungal colonization and/or infection in non-neutropenic critically ill patients: results of the EPCAN observational study. Eur J Clin Microbiol Infect Dis 28:233–242PubMedCrossRef Leon C, Alvarez-Lerma F, Ruiz-Santana S et al (2009) Fungal colonization and/or infection in non-neutropenic critically ill patients: results of the EPCAN observational study. Eur J Clin Microbiol Infect Dis 28:233–242PubMedCrossRef
3.
go back to reference Olaechea PM, Palomar M, Leon-Gil C et al (2004) Economic impact of Candida colonization and Candida infection in the critically ill patient. Eur J Clin Microbiol Infect Dis 23:323–330PubMedCrossRef Olaechea PM, Palomar M, Leon-Gil C et al (2004) Economic impact of Candida colonization and Candida infection in the critically ill patient. Eur J Clin Microbiol Infect Dis 23:323–330PubMedCrossRef
4.
go back to reference Zaoutis TE, Argon J, Chu J et al (2005) The epidemiology and attributable outcomes of candidemia in adults and children hospitalized in the United States: a propensity analysis. Clin Infect Dis 41:1232–1239PubMedCrossRef Zaoutis TE, Argon J, Chu J et al (2005) The epidemiology and attributable outcomes of candidemia in adults and children hospitalized in the United States: a propensity analysis. Clin Infect Dis 41:1232–1239PubMedCrossRef
5.
go back to reference McKinnon PS, Goff DA, Kern JW et al (2001) Temporal assessment of Candida risk factors in the surgical intensive care unit. Arch Surg 136:1401–1408PubMedCrossRef McKinnon PS, Goff DA, Kern JW et al (2001) Temporal assessment of Candida risk factors in the surgical intensive care unit. Arch Surg 136:1401–1408PubMedCrossRef
6.
go back to reference Chen S, Slavin M, Nguyen Q et al (2006) Active surveillance for candidemia, Australia. Emerg Infect Dis 12:1508–1516PubMed Chen S, Slavin M, Nguyen Q et al (2006) Active surveillance for candidemia, Australia. Emerg Infect Dis 12:1508–1516PubMed
7.
go back to reference Leone M, Albanese J, Antonini F et al (2003) Long-term epidemiological survey of Candida species: comparison of isolates found in an intensive care unit and in conventional wards. J Hosp Infect 55:169–174PubMedCrossRef Leone M, Albanese J, Antonini F et al (2003) Long-term epidemiological survey of Candida species: comparison of isolates found in an intensive care unit and in conventional wards. J Hosp Infect 55:169–174PubMedCrossRef
8.
go back to reference Nguyen MH, Peacock JE Jr, Morris AJ et al (1996) The changing face of candidemia: emergence of non-Candida albicans species and antifungal resistance. Am J Med 100:617–623PubMedCrossRef Nguyen MH, Peacock JE Jr, Morris AJ et al (1996) The changing face of candidemia: emergence of non-Candida albicans species and antifungal resistance. Am J Med 100:617–623PubMedCrossRef
9.
go back to reference Presterl E, Daxbock F, Graninger W et al (2007) Changing pattern of candidaemia 2001–2006 and use of antifungal therapy at the University Hospital of Vienna, Austria. Clin Microbiol Infect 13:1072–1076PubMedCrossRef Presterl E, Daxbock F, Graninger W et al (2007) Changing pattern of candidaemia 2001–2006 and use of antifungal therapy at the University Hospital of Vienna, Austria. Clin Microbiol Infect 13:1072–1076PubMedCrossRef
10.
go back to reference Charles PE, Doise JM, Quenot JP et al (2003) Candidemia in critically ill patients: difference of outcome between medical and surgical patients. Intensive Care Med 29:2162–2169PubMedCrossRef Charles PE, Doise JM, Quenot JP et al (2003) Candidemia in critically ill patients: difference of outcome between medical and surgical patients. Intensive Care Med 29:2162–2169PubMedCrossRef
11.
go back to reference Pittet D, Monod M, Suter PM et al (1994) Candida colonization and subsequent infections in critically ill surgical patients. Ann Surg 220:751–758PubMedCrossRef Pittet D, Monod M, Suter PM et al (1994) Candida colonization and subsequent infections in critically ill surgical patients. Ann Surg 220:751–758PubMedCrossRef
12.
go back to reference Lipsett PA (2006) Surgical critical care: fungal infections in surgical patients. Crit Care Med 34:S215–S224PubMedCrossRef Lipsett PA (2006) Surgical critical care: fungal infections in surgical patients. Crit Care Med 34:S215–S224PubMedCrossRef
13.
go back to reference Dimopoulos G, Ntziora F, Rachiotis G et al (2008) Candida albicans versus non-albicans intensive care unit-acquired bloodstream infections: differences in risk factors and outcome. Anesth Analg 106:523–529PubMedCrossRef Dimopoulos G, Ntziora F, Rachiotis G et al (2008) Candida albicans versus non-albicans intensive care unit-acquired bloodstream infections: differences in risk factors and outcome. Anesth Analg 106:523–529PubMedCrossRef
14.
go back to reference Toya SP, Schraufnagel DE, Tzelepis GE (2007) Candiduria in intensive care units: association with heavy colonization and candidaemia. J Hosp Infect 66:201–206PubMedCrossRef Toya SP, Schraufnagel DE, Tzelepis GE (2007) Candiduria in intensive care units: association with heavy colonization and candidaemia. J Hosp Infect 66:201–206PubMedCrossRef
15.
go back to reference Wey SB, Mori M, Pfaller MA et al (1989) Risk factors for hospital-acquired candidemia. A matched case-control study. Arch Intern Med 149:2349–2353PubMedCrossRef Wey SB, Mori M, Pfaller MA et al (1989) Risk factors for hospital-acquired candidemia. A matched case-control study. Arch Intern Med 149:2349–2353PubMedCrossRef
16.
go back to reference Blot S, Dimopoulos G, Rello J et al (2008) Is Candida really a threat in the ICU? Curr Opin Crit Care 14:600–604PubMedCrossRef Blot S, Dimopoulos G, Rello J et al (2008) Is Candida really a threat in the ICU? Curr Opin Crit Care 14:600–604PubMedCrossRef
17.
go back to reference Sandven P, Qvist H, Skovlund E et al (2002) Significance of Candida recovered from intraoperative specimens in patients with intra-abdominal perforations. Crit Care Med 30:541–547PubMedCrossRef Sandven P, Qvist H, Skovlund E et al (2002) Significance of Candida recovered from intraoperative specimens in patients with intra-abdominal perforations. Crit Care Med 30:541–547PubMedCrossRef
18.
19.
go back to reference Montravers P, Dupont H, Gauzit R et al (2006) Candida as a risk factor for mortality in peritonitis. Crit Care Med 34:646–652PubMedCrossRef Montravers P, Dupont H, Gauzit R et al (2006) Candida as a risk factor for mortality in peritonitis. Crit Care Med 34:646–652PubMedCrossRef
20.
go back to reference Hughes MG, Evans HL, Lightfoot L et al (2003) Does prior transfusion worsen outcomes from infection in surgical patients? Surg Infect (Larchmt) 4:335–343CrossRef Hughes MG, Evans HL, Lightfoot L et al (2003) Does prior transfusion worsen outcomes from infection in surgical patients? Surg Infect (Larchmt) 4:335–343CrossRef
21.
go back to reference Falagas ME, Apostolou KE, Pappas VD (2006) Attributable mortality of candidemia: a systematic review of matched cohort and case-control studies. Eur J Clin Microbiol Infect Dis 25:419–425PubMedCrossRef Falagas ME, Apostolou KE, Pappas VD (2006) Attributable mortality of candidemia: a systematic review of matched cohort and case-control studies. Eur J Clin Microbiol Infect Dis 25:419–425PubMedCrossRef
22.
go back to reference Parkins MD, Sabuda DM, Elsayed S et al (2007) Adequacy of empirical antifungal therapy and effect on outcome among patients with invasive Candida species infections. J Antimicrob Chemother 60:613–618PubMedCrossRef Parkins MD, Sabuda DM, Elsayed S et al (2007) Adequacy of empirical antifungal therapy and effect on outcome among patients with invasive Candida species infections. J Antimicrob Chemother 60:613–618PubMedCrossRef
23.
go back to reference Leon C, Ruiz-Santana S, Saavedra P et al (2006) A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization. Crit Care Med 34:730–737PubMedCrossRef Leon C, Ruiz-Santana S, Saavedra P et al (2006) A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization. Crit Care Med 34:730–737PubMedCrossRef
Metadata
Title
Candida Isolation in Patients Hospitalized on a Surgical Ward: Significance and Mortality-Related Factors
Authors
J. Marchena-Gomez
T. Saez-Guzman
M. Hemmersbach-Miller
A. Conde-Martel
V. Morales-Leon
A. Bordes-Benitez
M. A. Acosta-Merida
Publication date
01-09-2009
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 9/2009
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-009-0120-5

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