Candida as a risk factor for mortality in peritonitis.

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Clinical Microbiology

Background:

• The clinical significance of Candida in peritoneal fluid is debated.
• Previous studies have not clearly distinguished between community-acquired and nosocomial peritonitis.
• Differentiating the role of Candida in these settings is crucial for understanding patient outcomes.

Purpose of the Study:

• To differentiate the pathogenic role of Candida in community-acquired versus nosocomial peritonitis.
• To assess the impact of Candida isolation on mortality and morbidity in intensive care unit (ICU) patients.
• To identify independent risk factors for mortality in peritonitis patients.

Main Methods:

• A multi-center, retrospective, case-control study involving ICU patients.
• Cases: patients with Candida in peritoneal fluid; Controls: patients without yeast.
• Matching for infection type, severity (Simplified Acute Physiology Score II), age, and hospitalization duration.

Main Results:

• 91 cases and 168 controls were matched; no significant differences in baseline characteristics or overall mortality.
• A significant interaction between mortality and peritonitis type necessitated separate analyses.
• Candida isolation significantly increased mortality in nosocomial peritonitis (48% vs. 28%, p<.01).
• Upper GI source and Candida isolation were independent risk factors for mortality in nosocomial peritonitis.

Conclusions:

• Candida isolation is an independent risk factor for mortality in nosocomial peritonitis.
• Candida isolation does not appear to be an independent risk factor for mortality in community-acquired peritonitis.
• These findings emphasize the importance of distinguishing peritonitis origins when evaluating Candida's impact.