Risk Factors for Developing Candidemia after Gastrointestinal Perforation and/or Ischemia and Its Outcomes: A Matched...

Area of Science:

• Infectious Diseases
• Surgical Critical Care
• Mycology

Background:

• Candidemia is a severe complication following gastrointestinal (GI) perforation and/or ischemia.
• Existing research often groups candidemia with intra-abdominal candidiasis (IAC), obscuring candidemia-specific risk factors.
• This study aimed to identify unique risk factors and outcomes associated with candidemia in this patient population.

Purpose of the Study:

• To identify specific risk factors for candidemia in patients with GI perforation and/or ischemia.
• To evaluate the outcomes associated with candidemia in this cohort.
• To inform targeted surveillance and early antifungal treatment strategies.

Main Methods:

• A single-center, retrospective matched case-control study was conducted.
• Adult patients undergoing emergency surgery for GI perforation/ischemia were included.
• Cases of candidemia were matched 4:1 to controls based on age, comorbidity index, and surgical year, with conditional logistic regression used for analysis.

Main Results:

• Independent risk factors for candidemia included intra-abdominal candidiasis (IAC) (aOR: 5.51), upper GI injury (aOR: 4.28), and diffuse intra-abdominal contamination (aOR: 3.21).
• Candida albicans was the most common species (41.7%), followed by C. glabrata (33.3%) and C. parapsilosis (12.5%).
• Candidemia was associated with a significantly longer hospital length of stay (+13.97 days) but not with increased mortality or ventilation days.

Conclusions:

• Upper GI injury and diffuse abdominal contamination are key independent risk factors for candidemia post-GI perforation/ischemia.
• These findings suggest that readily identifiable operative features can guide targeted surveillance.
• Selective early antifungal strategies may be beneficial, warranting prospective validation.