Identification of Risk Factors for Intra-Abdominal Candidiasis

Author(s):
Kelsey Habighorst; James Sanders; Sara Hennessy; Kristina Goff; Bingchun Wan; Meagan Johns

Background:

Intra-abdominal candidiasis (IAC) is associated with significant morbidity and mortality in hospitalized patients. Identifying high-risk populations may facilitate early and selective directed therapy in appropriate patients and avoid unwarranted treatment and any associated adverse effects in those who are low risk.

Hypothesis:

Unique risk factors exist for the development of IAC compared to other forms of invasive candidiasis.

Methods:

This retrospective, case-control study included patients greater than 18 years of age admitted from July 1, 2010 to July 1, 2021 who had a microbiologically confirmed intra-abdominal infection (gastrointestinal culture positive for either a Candida spp. [cases] or bacterial isolate [controls] collected intraoperatively or from a drain placed within 24 hours). Patients receiving peritoneal dialysis treatment or with a peritoneal dialysis catheter in place or treated at an outside hospital were excluded. Multivariable regression was utilized to identify independent risk factors for the development of IAC.

Results:

Five hundred and twenty-three patients were screened, and 250 met inclusion criteria (125 per cohort). Univariate analysis revealed the following were statistically different between cases and controls: acute kidney injury, absolute neutrophil count ˂ 500 cells/mm3, preexisting hemodialysis, gastric acid lowering agent exposure, immunosuppression, diabetes mellitus, admission to the intensive care unit (ICU), ICU length of stay, mechanical ventilation for > 48 hours prior to culture collection, presence of a central venous catheter, upper gastrointestinal tract procedure prior to culture collection, parenteral nutrition utilization, prior hospitalization within 90 days, exposure to corticosteroids, diagnosis of sepsis or septic shock, >1 abdominal drain in place prior to culture collection, >1 trip to the operating room for any major surgery prior to culture collection, or presence of an anastomotic leak at the time of culture collection. Multivariable analysis identified exposure to corticosteroids (Odds Ratio (OR) 5.79; 95% CI 2.52-13.32, p < 0.0001), upper gastrointestinal tract surgery (OR 3.51; 95% CI 1.25-9.87, p = 0.017), and mechanical ventilation (OR 3.09; 95% CI 1.5-6.37, p = 0.002) were independently associated with IAC. The AUROC and goodness of fit were 0.7813 and P=0.5024, respectively.

Conclusions:

Exposure to corticosteroids, upper gastrointestinal tract surgery, and mechanical ventilation are independent risk factors for the development of IAC suggesting these factors may help identify high-risk individuals requiring antifungal therapy.