Can yeast isolation be predicted in complicated secondary non-postoperative intra-abdominal infections?
Introduction:
The aim of this study was to create a predictive score for yeast isolation in patients with complicated non-postoperative intra-abdominal infections (CNPIAI) and to evaluate the impact of yeast isolation on outcome.
Methods:
All patients with a CNPIAI undergoing emergency surgery over a three-year period were included in the retrospective cohort (RC, n = 290). Patients with a yeast-positive peritoneal fluid culture (YP) were compared with patients with a yeast-negative culture (YN). Multivariate logistic regression was used to identify factors independently associated with yeast isolation and a predictive score was built. The score's performance was then established in the prospective cohort (PC, n = 152) over an 18-month period. Outcome of the whole cohort was evaluated and independent risks factors of mortality searched.
Results:
In the RC, 39 patients (13.4%) were YP. Four factors were independently associated with the YP group: length of stay before surgery ≥48 h (odds ratio (OR) (95% confidence interval (CI)) = 3.1 (1.4 to 6.9), P = 0.004, 1 point), per-operative cardiovascular failure (2.4 (1.1 to 5.8), P = 0.04, 1 point), generalized peritonitis (6.8 (2.7 to 16.7), P <0.001, 2 points) and upper gastrointestinal tract perforation (2.5 (1.2 to 5.6), P = 0.02, 1 point). In the PC, the area under the curve (95%CI) of the predictive score's receiver operating characteristic curve was 0.79 (0.72 to 0.86). For predicting an intra-abdominal candidiasis (IAC), a score ≥3 had a sensitivity of 0.60, a specificity of 0.84, a positive predictive value of 0.49 and a negative predictive value of 0.89. Furthermore, yeast isolation was associated with worse outcome and independently associated with mortality in the whole cohort (OR = 2.15; 95%CI (1.03 to 4.46), P = 0.04).
Conclusions:
The new predictive score can be used to rule out intra-abdominal candidiasis and thus avoid the initiation of antifungal treatment. It is suited to less severe infections than previously published scores. IAC is associated independently with an increased mortality in this population.
Insights
A new predictive score helps identify yeast in complicated intra-abdominal infections, aiding treatment decisions. Yeast isolation independently increases mortality risk in these patients.
Area of Science:
- Infectious Diseases
- Surgical Infections
- Mycology
Background:
- Complicated non-postoperative intra-abdominal infections (CNPIAI) present diagnostic challenges.
- Yeast isolation in CNPIAI impacts patient outcomes and treatment strategies.
Purpose of the Study:
- To develop a predictive score for yeast isolation in CNPIAI.
- To assess the impact of yeast isolation on patient outcomes and mortality.
Main Methods:
- Retrospective and prospective cohorts of patients with CNPIAI undergoing emergency surgery.
- Multivariate logistic regression to identify predictors of yeast isolation.
- Validation of a predictive score in a prospective cohort.
Main Results:
- Four factors independently predicted yeast isolation: prolonged pre-surgery stay, cardiovascular failure, generalized peritonitis, and upper GI perforation.
- The developed score demonstrated good performance in predicting intra-abdominal candidiasis (IAC).
- Yeast isolation was associated with worse outcomes and independently predicted mortality.
Conclusions:
- A novel predictive score can assist in ruling out intra-abdominal candidiasis (IAC), potentially avoiding unnecessary antifungal treatment.
- The score is applicable to less severe infections compared to existing tools.
- IAC is an independent risk factor for increased mortality in CNPIAI patients.
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