Intra-abdominal Candidiasis (IAC) Is Under-recognized, But Is The Most Common Type Of Invasive Candidiasis (IC) And Results In Poor Outcomes

Ref ID: 18753

Author:

M. Nguyen, MD – Professor 1, C. Clancy, MD – Associate Professor2;

Author address:

1Univ. of Pittsburgh, Pittsburgh, PA, 2Univ. of Pittsburgh and VA Pittsburgh, Pittsburgh, PA.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: IAC is accepted as 2nd most common form of IC, but it is poorly characterized. Methods: Observational study of patients (pts) at our center with ≥ 1 sterile abdominal culture (+) for Candida in 2010-11. IAC included peritonitis and abscesses (IAA), and was classified as primary (spontaneous or dialysis-associated), secondary (seeded during GI perforation or surgery) or tertiary persistence/recurrence). Results: 199 pts had IC. Candidemia, IAC, IAC+candidemia and other deep-seated candidiasis accounted for 28%, 53%, 7% and 13% of IC, respectively. IAC was primary and secondary in 15% and 85% of pts, respectively. Secondary IAC resulted from surgery (45%), perforation (30%), transmural colitis including C. diff and Crohns disease (16%), and other causes (9%). 51% of pts with post-surgical IAC had a colon procedure, 24% small bowel (SB), 15% liver and 10% esophagus. 63% of perforations involved SB, 25% G-tube displacement and 11% colon. 50% of pts with IAC had IAA, 42% peritonitis and 8% peritonitis+IAA. 58% of IAC was due to C. albicans, 23% C. glabrata, 8% C. parapsilosis, 4% C. tropicalis; 65% of pts were co-infected with bacteria. All pts had (+) IA cultures for Candida, but only 12% had (+) blood cultures. The mortality rate among pts with IAC was 23%, and was worst for pts with perforation (50% vs 11%; p=0.046). 27% of survivors developed tertiary IAC that required prolonged antifungal therapy and/or repeated surgeries. Overall, 38% of pts with IAC underwent surgical drainage but did not initially receive an antifungal agent; 50% of these pts developed persistent IAC, and 20% died. Conclusions: IAC was the most common cause of IC, and was associated with high mortality and need for repeated surgeries. Clinicians could not reliably identify patients who were cured with surgical drainage alone, showing that all pts require antifungal therapy in addition to drainage. Blood cultures have poor sensitivity, and IAC is under-recognized because of a dependence on IA cultures for diagnosis. Alternative non-invasive tests that expedite diagnoses are needed.

Abstract Number: M-1685

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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