Potential influence of antisecretory therapy on the development of Candida-associated intraabdominal infection

Concerns surrounding the potential extra gut complication of gastric acid suppression are becoming increasingly realized.

To determine whether chronic antisecretory treatment with a proton pump inhibitor (PPI) or histamine(2)-receptor antagonist (H(2)RA) is associated with the presence of Candida spp. in cases of complicated intraabdominal infection.

We conducted a case-controlled study of adult surgical intensive care unit patients with complicated intraabdominal infection during a 5-year period. Exclusion criteria consisted of primary peritonitis, diagnosis of intraabdominal infection more than 72 hours before hospital admission, or a stay in the intensive care unit of less than 72 hours. Patients were categorized into either the antisecretory group (H(2)RA or PPI therapy prior to admission) or control group (no prior antisecretory therapy).

One hundred eighteen patients met inclusion criteria. Chronic antisecretory (n = 41) and control (n = 77) patients were similar except in median age (69.0 vs 59.0 y; p = 0.026) and preadmission antibiotic use (36.6% vs 15.6%; p = 0.010). The 2 groups had a similar proportion of patients with Candida (30.3% vs 32.1%; p = 0.857); the cultures included C. albicans, C. glabrata, and C. parapsilosis. Yeast was recovered more often in patients diagnosed with community-acquired intraabdominal infection and in patients who had used PPIs before hospital admission (p = 0.066). Additionally, Candida was cultured more often in antisecretory patients with a history of prior abdominal surgery than in control patients (91.7% vs 62.5%; p = 0.066).

No significant difference was found in the number of patients in the antisecretory and control groups from whom peritoneal Candida was recovered. However, patients with prior abdominal surgery and those in the community with chronic PPI use may be predisposed to Candida-associated intraabdominal infections.