Risk Factors for Intra-Abdominal Candidiasis in Intensive Care Units: Results from EUCANDICU Study

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Surgical Infections

Background:

• Intra-abdominal infections (IAIs) are common in ICUs, with high mortality rates (20-50%).
• Candida species cause 10-30% of IAIs, leading to intra-abdominal candidiasis (IAC).
• Identifying risk factors for IAC is crucial for timely intervention in critically ill patients.

Purpose of the Study:

• To assess risk factors associated with the development of intra-abdominal candidiasis (IAC).
• To identify patient subgroups at higher risk for IAC in the intensive care unit (ICU) setting.

Main Methods:

• A case-control study was conducted across 26 European ICUs from January 2015 to December 2016.
• Case patients had microbiologically confirmed IAC (≥48h post-ICU admission).
• Control patients were matched 1:1 for time at risk, ICU ward, and study period.

Main Results:

• Recurrent gastrointestinal perforation (OR 13.90), anastomotic leakage (OR 6.61), and abdominal drains (OR 6.58) were strongly associated with IAC.
• Prior antibiotic (OR 3.78) and antifungal (OR 4.26) use were also independent risk factors for IAC development.
• Severe hepatic failure and parenteral nutrition were associated on univariate but not multivariate analysis.

Conclusions:

• Gastrointestinal perforation, anastomotic leakage, abdominal drains, and prior antimicrobial use are significant predictors of IAC.
• These factors can help identify high-risk ICU patients who may benefit from early antifungal treatment.
• Further prospective studies are needed to guide early antifungal therapy decisions in at-risk populations.