Candidiasis intraabdominal: epidemiología, predictores de elección para el tratamiento y factores asociados con la mortalidad
- Autores: Leonel Lagunes
- Directores de la Tesis: Jordi Rello Condomines (dir. tes.), Magdalena Campins Martí (dir. tes.), Matteo Bassetti (dir. tes.)
- Lectura: En la Universitat Autònoma de Barcelona ( España ) en 2017
- Idioma: español
- Tribunal Calificador de la Tesis: Salvadora Benito Palma (presid.), M. Teresa Pont Castellana (secret.), Juan Pablo Horcajada Gallego (voc.)
- Programa de doctorado: Programa de Doctorado en Medicina por la Universidad Autónoma de Barcelona
- Calificación: Sobresaliente
- Materias:
- Enlaces
- Tesis en acceso abierto en: TESEO
- Resumen
INTRODUCTION: Candida spp. are commonly found in humans. They colonize the skin and mucosal surfaces of most healthy individuals. In recent years, the prevalence of sepsis due to fungal organisms has risen by more than 200% and they have become the third most common pathogen isolated from blood samples in large epidemiological studies in critically ill patients. Patients with systemic fungal infection by Candida can be subdivided into three groups: those who present with bloodstream infection (candidemia), those who develop deep-seated candidiasis (most frequently intraabdominal candidiasis), and those who develop a combination of the two. High mortality rates, ranging from 27% to 55%, have recently been reported.
METHODS: Multinational multicenter retrospective cohort study conducted at 13 teaching hospitals in four countries (Italy, Greece, Spain, and Brazil), over a three-year period (2011-2013). All cases were recorded continuously. An episode of IAC was defined according to the 2013 European consensus • First article “Predictors of choice of initial antifungal treatment of intraabdominal candidiasis” gives a global pattern of epidemiology on this matter and the implication regarding the decision of which antifungal to prescribe when facing an IAC patient. • Second article “Association between source control and mortality in 258 patients with intra-abdominal candidiasis: A retrospective multicentric analysis comparing intensive care versus surgical wards in Spain” is centered in Spain cohort in order to reduce the possible bias of admission to an ICU according to bed availability or treatment policies in different countries regarding where the patient has been diagnosed of an IAC episode. RESULTS: 481 cases of IAC were recorded in four countries in 13 hospitals. Most patients were male 276 (57,3%), median age 65 (Interquartile range 25-75 (IQR25-75): 53-75), with a median APACHE II score at diagnosis of 15 (IQR25-75: 9-20). First type of IAC was peritonitis in 223 patients (46,3%) mostly secondary peritonitis in 189 patients (39,2%) followed by abdominal abscess in 138 (28,6%). Patients were mostly at surgery ward at diagnosis 252 (52,3%) followed by Intensive care unit in 132 (27,4). Candida albicans was the most common species recovered accounting for 314 (65,1%) followed by Candida glabrata in 88 (18,3%) and Candida tropicalis in 37 (7,7%), Candida parapsillosis in 23 (4,8%) and finally Candida Kruseii in 13 (2,7%). Mortality in whole study population at day 30 was of 129 (26,8%) CONCLUSIONS: Echinocandins were the first choice as initial antifungal treatment in patients with IAC and septic shock and in patients in surgical wards at the time of diagnosis. No statistical difference in mortality was observed between the two regimens in IAC episodes, even though echinocandins were administered to more severe patients. Our findings suggest no differences in source of infection or Candida species at ICU or surgical wards were observed. Adequate initial treatment was higher in the ICU population and has stronger impact on outcome particularly in the subset with higher severity. Source control remains the main goal for decreasing mortality of IAC episodes in and outside the ICU, emphasizing the contribution of the surgeon in intra-abdominal infections.
