Temporal changes in fungal epidemiology in ICU post-operative peritonitis cases
Related Experiment Video
Updated: Jan 6, 2026
Histological Quantification to Determine Lung Fungal Burden in Experimental Aspergillosis
Published on: March 9, 2018
Philippe Montravers1,2,3, Christine Bonnal4, Stefan Andrei5
1Department of Anaesthesiology and Surgical Intensive Care, DMU PARABOL, APHP, Hôpital Bichat, 75018, Paris, France. philippe.montravers@aphp.fr.
Purpose:
Recent changes in the mycological profile have been reported in several life-threatening infections, but no data have assessed this issue in postoperative peritonitis (POP).
Methods:
This retrospective monocentric analysis (1999-2019) evaluated the temporal changes of fungi collected from POP samples in intensive care unit (ICU) patients and assessed the adequacy of antifungal therapy (AFT) and the prognosis.
Results:
Overall, 1,389 microorganisms were cultured from surgical samples in 464 ICU patients, including 186 (40%) patients harbouring fungi (11 fungaemia). Growing proportions of fungi were observed over time (p < 0.01), related to increased rates of Candida albicans and C. non-albicans (p = 0.01 and p < 0.01, respectively). A significantly increased prescription of empirical AFT was observed during the study period (p < 0.0001). Adequate empirical AFT was achieved in 93/186 (50%) patients in the fungal group. Documented AFT was given in 163/174 (94%) patients in the fungal group for a median duration of 14 [9-21] days, mainly with fluconazole. The ICU and hospital mortality rates were similar in bacterial and fungal groups. However, we observed a significant increase in the duration of mechanical ventilation and ICU stay in the fungal group.
Conclusion:
We observed high and growing proportions of fungi in patients treated for POP associated to increasing proportions of both C. albicans and C. non-albicans. Adequate AFT was achieved in all cases with caspofungin, but fluconazole remains an acceptable option for de-escalation. Our data suggest that, in ICU patients with POP, the severity of illness, rather than adequate AFT, drives clinical outcomes.
Insights
Fungal infections are increasing in postoperative peritonitis (POP) patients, with rising rates of Candida species. While antifungal therapy (AFT) is often adequate, illness severity impacts outcomes more than AFT itself.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Critical Care Medicine
Background:
- Fungal infections are a growing concern in critical care settings.
- Limited data exists on fungal prevalence in postoperative peritonitis (POP).
Purpose of the Study:
- To investigate temporal changes in fungal profiles in POP patients.
- To assess antifungal therapy (AFT) adequacy and patient prognosis in POP.
Main Methods:
- Retrospective monocentric analysis of ICU patients with POP from 1999-2019.
- Evaluation of fungal cultures, AFT, and clinical outcomes.
Main Results:
- Fungal prevalence in POP increased significantly over time (p < 0.01), with rising Candida albicans and non-albicans rates.
- Adequate empirical AFT was achieved in 50% of fungal cases; 94% received documented AFT, primarily fluconazole.
- While mortality was similar, fungal infections led to longer mechanical ventilation and ICU stays.
Conclusions:
- High and increasing fungal proportions, including Candida species, are observed in POP.
- Caspofungin showed adequate AFT, with fluconazole suitable for de-escalation.
- In ICU patients with POP, illness severity is the primary driver of clinical outcomes, not AFT adequacy.
Related Concept Videos
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:26Healthcare Associated Infections I: Iatrogenic, Exogenic and Endogenic
HAIs significantly increase the cost of health care. Extended stays in healthcare institutions, increased disability, increased costs of medications, including specialized antibiotics, and prolonged recovery times add to the patient's expenses and the healthcare institution and funding bodies.