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Risk Factors for Developing Candidemia after Gastrointestinal Perforation and/or Ischemia and Its Outcomes: A Matched
Myeongji Kim1, Nischal Ranganath1,2, Sofia Molina Garcia1
1Division of Public Health, Infectious Diseases, and Occupational medicine, Mayo Clinic, Rochester, Minnesota, USA.
Background:
Candidemia is a serious complication after gastrointestinal (GI) perforation and/or ischemia, yet most evidence pools candidemia with intra-abdominal candidiasis (IAC). We sought candidemia-specific risk factors after GI perforation and/or ischemia and evaluated associated outcomes.
Methods:
We conducted a single-center, retrospective matched case-control study of adults undergoing emergency surgical procedure for GI perforation and/or ischemia and admitted to a surgical intensive care unit. Cases with candidemia during index admission were matched 4:1 to controls by age, Charlson Comorbidity Index, and surgical procedure year. Conditional logistic regression assessed pre-specified risk factors, and exploratory outcomes included mortality, length of stay, and days on invasive ventilation.
Results:
Twenty-four cases were matched to 99 controls. Factors identified to be independently associated with candidemia include the presence of IAC (adjusted OR [aOR]: 5.51, 95% CI: 1.61, 18.89; p = 0.007), upper GI injury (aOR: 4.28, 95% CI: 1.52-12.08; p = 0.006), and diffuse intra-abdominal contamination, compared with contained/none (aOR: 3.21, 95% CI: 1.06-9.74; p = 0.040). Among candidemia cases, species distribution was Candida albicans 41.7%, C. glabrata 33.3%, C. parapsilosis 12.5%, with single cases of C. tropicalis, C. krusei, and C. dubliniensis. Candidemia was associated with a longer hospital length of stay (+13.97 d; 95% CI: 0.90-27.04; p = 0.036), without significant differences in ICU stay, duration of invasive ventilation, or mortality.
Conclusions:
After GI perforation and/or ischemia, the risk of candidemia is highest in patients with upper GI injury and diffuse contamination, independent of IAC. These readily identifiable operative features may guide targeted surveillance and selective early antifungal strategies. Prospective validation is warranted.
Insights
Candidemia risk after gastrointestinal (GI) perforation is linked to upper GI injury and diffuse contamination, independent of intra-abdominal candidiasis (IAC). These factors can guide early antifungal strategies.
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.
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