Infectious Diseases Division, Santa Maria Misericordia University Hospital, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy,
Intensive Care Med. 2015 Sep;41(9):1601-10. doi: 10.1007/s00134-015-3866-2. Epub 2015 May 19.
Clinical data on patients with intra-abdominal candidiasis (IAC) is still scarce.
We collected data from 13 hospitals in Italy, Spain, Brazil, and Greece over a 3-year period (2011-2013) including patients from ICU, medical, and surgical wards.
A total of 481 patients were included in the study. Of these, 27% were hospitalized in ICU. Mean age was 63 years and 57% of patients were male. IAC mainly consisted of secondary peritonitis (41%) and abdominal abscesses (30%); 68 (14%) cases were also candidemic and 331 (69%) had concomitant bacterial infections. The most commonly isolated Candida species were C. albicans (n = 308 isolates, 64%) and C. glabrata (n = 76, 16%). Antifungal treatment included echinocandins (64%), azoles (32%), and amphotericin B (4%). Septic shock was documented in 40.5% of patients. Overall 30-day hospital mortality was 27% with 38.9% mortality in ICU. Multivariate logistic regression showed that age (OR 1.05, 95% CI 1.03-1.07, P < 0.001), increments in 1-point APACHE II scores (OR 1.05, 95% CI 1.01-1.08, P = 0.028), secondary peritonitis (OR 1.72, 95% CI 1.02-2.89, P = 0.019), septic shock (OR 3.29, 95% CI 1.88-5.86, P < 0.001), and absence of adequate abdominal source control (OR 3.35, 95% CI 2.01-5.63, P < 0.001) were associated with mortality. In patients with septic shock, absence of source control correlated with mortality rates above 60% irrespective of administration of an adequate antifungal therapy.
Low percentages of concomitant candidemia and high mortality rates are documented in IAC. In patients presenting with septic shock, source control is fundamental.
目前有关腹腔内念珠菌病（IAC）患者的临床数据仍然有限。
我们收集了意大利、西班牙、巴西和希腊的 13 家医院在 3 年期间（2011-2013 年）的数据，包括 ICU、内科和外科病房的患者。
共有 481 例患者纳入本研究。其中，27%的患者住院于 ICU。患者平均年龄为 63 岁，57%为男性。IAC 主要由继发性腹膜炎（41%）和腹腔脓肿（30%）引起；68 例（14%）为念珠菌血症，331 例（69%）合并细菌感染。最常分离到的念珠菌种类为白色念珠菌（n = 308 株，64%）和光滑念珠菌（n = 76 株，16%）。抗真菌治疗包括棘白菌素（64%）、唑类（32%）和两性霉素 B（4%）。40.5%的患者存在感染性休克。总体 30 天院内死亡率为 27%，ICU 死亡率为 38.9%。多变量 logistic 回归显示，年龄（OR 1.05，95%CI 1.03-1.07，P < 0.001）、APACHE II 评分增加 1 分（OR 1.05，95%CI 1.01-1.08，P = 0.028）、继发性腹膜炎（OR 1.72，95%CI 1.02-2.89，P = 0.019）、感染性休克（OR 3.29，95%CI 1.88-5.86，P < 0.001）和未进行充分的腹部源头控制（OR 3.35，95%CI 2.01-5.63，P < 0.001）与死亡率相关。在发生感染性休克的患者中，即使给予适当的抗真菌治疗，未能进行源头控制也与 60%以上的死亡率相关。
IAC 患者合并念珠菌血症的比例较低，死亡率较高。在出现感染性休克的患者中，源头控制至关重要。
