Intra-Abdominal Candidiasis in Cancer Patients: A 10-Year Experience in a Middle-Income Country.

IF 4.1 2区医学 Q1 DERMATOLOGY Mycoses Pub Date : 2024-10-01 DOI:10.1111/myc.13807

Bianca Leal de Almeida, Vitor Ciampone Arcieri, Danilo Mardegam Razente, Maristela Pinheiro Freire, Thais Guimarães, Evangelina da Motta Pacheco Alves de Araújo, Edson Abdala, Marcello Mihailenko Chaves Magri

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Abstract

Background: Invasive candidiasis (IC) represents a significant threat to both mortality and morbidity, especially among vulnerable populations. Intra-abdominal candidiasis (IAC) frequently occurs in critically ill and cancer patients, with these specific groups carrying a heightened risk for such invasive fungal infections. Despite this, there is a noticeable lack of attention to IAC in cancer patients within the literature, highlighting a critical gap that requires urgent consideration.

Objectives: This study aimed to explore the clinical and epidemiological characteristics of IAC and identify prognostic factors in a cancer centre in a middle-income country over 10 years.

Patients/methods: A retrospective cohort observational study of adults diagnosed with IAC was conducted at the Instituto do Cancer do Estado de São Paulo (ICESP), a tertiary hospital specialising in oncological diseases with 499 beds, including 85 intensive care unit (ICU) beds, from December 2009 through May 2021.

Results: A total of 128 episodes were included: 67.2% admitted to the ICU; 54.7% males; and median age 62 years. The predominant diagnosis was peritonitis (75.8%). Blood culture samples were collected from 128 patients upon admission, revealing candidemia in 17.2% (22). The most frequently isolated were C. albicans (n = 65, 50.8%) and C. glabrata (n = 42, 32.8%). Antifungal treatment was administered to 91 (71%) patients, with fluconazole (64.8%) and echinocandins (23.4%) being the most common choices. A significant proportion of these patients had a history of abdominal surgery or antibiotic use. Independent factors associated with 30-day mortality included the median Sequential Organ Failure Assessment (SOFA) score of 6 (OR = 1.30, 95% CI 1.094-1.562, p = 0.003), days of treatment (median 10.5) (OR = 0.93, 95% CI 0.870-0.993, p = 0.031) and abdominal source control (78.1%) (OR = 0.148, 95% CI 0.030-0.719, p = 0.018). The 30-day mortality rate was 41.1%.

Conclusions: Our study underscores the critical importance of implementing effective source control as a key strategy for reducing mortality in IAC.

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癌症患者腹腔内念珠菌病：一个中等收入国家的十年经验

背景：侵袭性念珠菌病（IC）对死亡率和发病率都构成重大威胁，尤其是在弱势群体中。腹腔内念珠菌病（IAC）经常发生在危重病人和癌症患者中，这些特殊人群罹患此类侵袭性真菌感染的风险更高。尽管如此，文献中明显缺乏对癌症患者腹腔念珠菌感染的关注，这凸显了一个急需考虑的关键缺口：本研究旨在探讨 IAC 的临床和流行病学特征，并确定一个中等收入国家癌症中心 10 年来的预后因素：圣保罗州癌症研究所（ICESP）是一家肿瘤专科三级医院，拥有499张病床，其中包括85张重症监护病房（ICU）病床，自2009年12月至2021年5月对诊断为IAC的成人进行了一项回顾性队列观察研究：结果：共纳入 128 例病例：67.2% 入住重症监护室；54.7% 为男性；中位年龄为 62 岁。主要诊断为腹膜炎（75.8%）。128 名患者在入院时采集了血培养样本，结果显示 17.2% 的患者（22 例）患有念珠菌血症。最常分离出的是白念珠菌（65 人，50.8%）和光滑念珠菌（42 人，32.8%）。91 名（71%）患者接受了抗真菌治疗，其中氟康唑（64.8%）和棘白菌素（23.4%）是最常见的选择。其中相当一部分患者有腹部手术史或抗生素使用史。与30天死亡率相关的独立因素包括：序贯器官衰竭评估（SOFA）中位数为6分（OR = 1.30，95% CI 1.094-1.562，p = 0.003）、治疗天数（中位数10.5）（OR = 0.93，95% CI 0.870-0.993，p = 0.031）和腹腔源控制（78.1%）（OR = 0.148，95% CI 0.030-0.719，p = 0.018）。30天死亡率为41.1%：我们的研究强调了实施有效的病源控制作为降低 IAC 死亡率的关键策略的重要性。

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来源期刊

Mycoses 医学-皮肤病学

CiteScore

10.00

自引率

8.20%

发文量

143

审稿时长

6-12 weeks

期刊介绍： The journal Mycoses provides an international forum for original papers in English on the pathogenesis, diagnosis, therapy, prophylaxis, and epidemiology of fungal infectious diseases in humans as well as on the biology of pathogenic fungi. Medical mycology as part of medical microbiology is advancing rapidly. Effective therapeutic strategies are already available in chemotherapy and are being further developed. Their application requires reliable laboratory diagnostic techniques, which, in turn, result from mycological basic research. Opportunistic mycoses vary greatly in their clinical and pathological symptoms, because the underlying disease of a patient at risk decisively determines their symptomatology and progress. The journal Mycoses is therefore of interest to scientists in fundamental mycological research, mycological laboratory diagnosticians and clinicians interested in fungal infections.