214. The Impact of Antifungal Therapy on the Outcomes of Intra-Abdominal Candidiasis
Session: Poster Abstract Session: Candida Infection
Thursday, October 8, 2015
Room: Poster Hall

Background: Intra-abdominal candidiasis (IAC) is an important type of invasive candidiasis that is as common as candidemia. Surgical intervention is recognized as a key component of successful management. The benefit of antifungal therapy in IAC is not established.

Methods: We performed a retrospective study of adult patients with microbiological evidence of IAC diagnosed at the University of Pittsburgh Medical Center in 2012-2013.

Results: 163 patients had IAC. 25% were immunocompromised, including 12% with solid organ transplant (SOT). IAC was preceded by abdominal surgery in 53%. 63% (n=103) had gastrointestinal (GI) luminal disease, most commonly involving the colon (followed by small bowel, stomach and duodenum). Types of IAC were primary peritonitis (5%, all associated with cirrhosis), secondary peritonitis (32%), intra-abdominal abscesses (55%), cholangitis (3%) and infected pancreatic necrosis (5%). At disease onset, 18% had septic shock, which was more common in patients with peritonitis than abscess (p=0.06).

C. albicans was most common (57%), followed by C. glabrata (24%), C. parapsilosis (10%), and other Candida species. Infection with two Candida species occurred in 10%, and bacterial co-infection in 68%. C. glabrata was more likely than C. albicans to cause IAC in patients with ≥2 prior abdominal surgeries (53% vs 22%, p=0.02), and to be involved in co-infections with multiple-drug resistant Gram-negative bacteria (14% vs 2%; p=0.005).

All patients underwent drainage procedures. Only 72% received antifungal treatment within 5 days of IAC. The 100-day mortality rate was 28%. Primary peritonitis was associated with the highest mortality (89%), followed by secondary peritonitis (40%) and abscesses (17%). Increased age (p=0.001) and SOT (p=0.05) were independent risk factors for death, while abscess was protective (p=0.001) by multivariate analysis. Among patients with GI luminal disease, intra-abdominal abscess (p=0.01) and antifungal therapy within 5 days (p=0.02) were protective against death.

Conclusion: IAC is associated with high mortality. We showed for the first time that early administration of an antifungal agent in conjunction with drainage and/or surgical intervention improved outcomes, especially among patients with GI luminal disease.

Pascalis Vergidis, MD, Matthew Marcott, B.S., Minh-Hong Nguyen, MD, Ryan K. Shields, PharmD, Seo Young Park, PhD and Cornelius Clancy, MD, University of Pittsburgh, School of Medicine, Pittsburgh, PA


P. Vergidis, None

M. Marcott, None

M. H. Nguyen, None

R. K. Shields, Merck: Investigator , Research grant
Astellas: Investigator , Research grant

S. Y. Park, None

C. Clancy, None

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