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Clinical Outcomes of Intra-Abdominal Candidiasis by Initial Antifungal Therapy
M Albanell-Fernández1,2, A Vergara3,4,5, F Marco3,4
1Pharmacy Service, Division of Medicines, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.
Background:
Intra-abdominal candidiasis (IAC) is a severe and heterogeneous infection associated with significant morbidity and mortality.
Objectives:
To evaluate outcomes of IAC according to initial antifungal therapy and to identify predictors of persistent infection and 30-day mortality.
Methods:
A retrospective non-randomised single-centre study (January 2020-February 2025) evaluated adult IAC according to the initial antifungal (azoles vs. echinocandins), assessing demographics, type, location, and persistent positive cultures, re-intervention, antifungal reintroduction, and 3- and 90-day mortality. Multivariate logistic regression identified predictors of persistent cultures and 30-day mortality, and inverse probability of treatment weighting (IPTW) addressed confounding in mortality analyses.
Results:
Among 154 patients (median age 64.5 years, 66.9% male), 102 received azoles and 52 echinocandins, with greater severity in the latter group. Persistent positive cultures occurred in 51.7% (46/89), without difference between groups. Factors associated with persistent positive cultures included concomitant candidemia, septic shock, previous antibiotic usage, and peritonitis. The 30-day mortality was 28.1% (higher with echinocandins, 38.5% vs. 22.8% in azole group, p = 0.041). Multivariate logistic regression and IPTW indicated that the initial antifungal therapy did not affect 30-day mortality, while septic shock (OR:2.2, 95% CI:1.0-4.9; p = 0.047) and age ≥ 60 years (OR:2.6, 95% CI:1.1-6.3; p = 0.032) were significantly associated with it.
Conclusions:
IAC remains a complex infection with substantial morbidity and mortality. Echinocandins are preferred in critically ill patients, but mortality did not differ significantly between initial echinocandin and azole treatment. Persistent positive cultures were linked to severe presentation, including peritonitis, candidemia, and septic shock, which required more frequent re-intervention, and consequently carried higher mortality.
Insights
Intra-abdominal candidiasis (IAC) is a severe infection. Initial antifungal choice (azoles vs. echinocandins) did not impact 30-day mortality, but septic shock and older age increased risk.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pharmacology
Background:
- Intra-abdominal candidiasis (IAC) presents significant morbidity and mortality.
- Understanding factors influencing IAC outcomes is crucial for patient management.
Purpose of the Study:
- Evaluate IAC outcomes based on initial antifungal therapy (azoles vs. echinocandins).
- Identify predictors of persistent infection and 30-day mortality in IAC patients.
Main Methods:
- Retrospective single-center study of 154 adult IAC patients (2020-2025).
- Compared outcomes between azole and echinodandin groups.
- Used multivariate logistic regression and IPTW to analyze predictors of mortality.
Main Results:
- Initial antifungal therapy did not significantly affect 30-day mortality.
- Septic shock and age ≥ 60 years were significant predictors of 30-day mortality.
- Persistent positive cultures were associated with severe presentations like peritonitis and candidemia.
Conclusions:
- IAC is a complex infection with high mortality.
- While echinocandins are used for critically ill patients, initial therapy choice did not alter mortality.
- Severe presentation factors, not initial antifungal, predict worse outcomes and higher mortality.
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