Candidainfection and colonization among non-trauma emergency surgery patients

Abstract

IntroductionCandida is a fungus, which accounts for nearly 96% of all opportunistic mycoses and is the fourth most common bloodstream pathogen in North American and seventh in European hospitals. 1,2 Among critically ill patients, candidiasis is associated with overall severity of illness, increased rate of invasive interventions, use of broadspectrum antibiotics and parenteral nutrition, which are all unavoidable among critically ill patients.3-5 Candidiasis prolongs both intensive care unit (ICU) and hospital stays and candidemia can increase hospital cost by $40,000 per survivor.6,7 Nonetheless, in a nationwide study the crude mortality of candidemia in the ICU was 47%. Even though candidiasis has been well studied in other critically ill patient groups such as trauma patients as well as in certain high-risk groups, such as patients with neutropenia, bone marrow transplant recipients or HIV-infected individuals, literature examining specific risk factors for candidiasis among non-trauma emergency surgery patients is lacking. This patient Background: candida is a significant pathogen among critically ill patients. however, candidiasis 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 1 st , 2002 to april 30 th , 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...

Candidainfection and colonization among trauma patients

“…11 Of note is that the criteria for Candida infection and the time period were similar to those in our study presented here. Nearly half of all fungal infections are manifested among surgical ICU patients 12 however when trauma is the primary etiology then these rates fall substantially.…”

Synergistic combinations of antifungals and anti-virulence agents to fight againstCandida albicans

“…3,4 Systemic infections caused by C. albicans have become a serious public health threaten in immunocompromised patients, organ transplantations, non-trauma emergency surgery, massive chemotherapy and implantable medical devices during the past several decades. [3][4][5][6] The development of antifungal drug discovery is relative slower than antibacterial antibiotics, and antifungal drug resistance reduce the efficacy of known antifungals. 7 The lack of new antifungal drugs and the limited therapeutic options call for new strategies to find novel antifungal candidates.…”

The Effect of Cumulative Length of Hospital Stay on the Antifungal Resistance of Candida Strains Isolated from Critically Ill Surgical Patients

“…We selected this particular population of critically ill surgical patients in order to increase the yield of Candida isolation (critical illness predisposes to the development of Candida). For the purposes of this study, we defined as emergency surgical disease all processes causing obstruction, perforation, bleeding, or inflammation that required an emergent intervention [23, 24]. Data on the demographic and clinical characteristics of the patients were prospectively collected during their hospital stay.…”

“…that are resistant to fluconazole. This study focused on patients with nontraumatic surgical illnesses, a population that has an established high risk for systemic candidiasis [23]. …”