LAUSR

Learning Objectives: Previous studies have evaluated risk factors for invasive candidiasis (IC) in critically ill patients. However, risk factors have not been evaluated exclusively in critically ill patients after abdominal surgery, a population that could benefit from the initiation of early empiric antifungal agents in the perioperative setting. The objective of this study was to determine the risk factors for IC in a surgical intensive care unit (SICU) population after intra-abdominal procedures (IAPs) involving the gastrointestinal tract. Methods: This retrospective, IRB-approved cohort study evaluated patients 18 years of age or older who were admitted over a one year period to the SICU after IAPs. Patients who received systemic antifungals two to 30 days prior to or for three or more days after the procedure were excluded. Patients were divided into two groups, those that developed IC and did not develop IC (non-IC). Patient characteristics were compared among both groups using the chi-squared test, or Student’s t-test as appropriate to identify risk factors for IC. All characteristics with a p-value of less than 0.2 were evaluated for inclusion into a multivariable logistic regression model to identify independent risk factors for IC. Results: Of the 149 patients who met the inclusion criteria, 23 were in the IC group and 126 were in the non-IC group. Bowel resection, bowel suture and open surgery with lavage were the most common IAPs and occurred in more than 60% of patients. More patients in the IC group had abscesses (39% vs 10%, p<0.001) and peritonitis (52% vs 24%, p=0.005). Candida albicans (65%) and Candida glabrata (22%) were the most common species isolated. Antibiotic use, total parenteral nutrition (TPN), and Candida colonization were identified as risk factors for IC after an unadjusted analysis. Multivariable analysis revealed that only TPN (OR 4.7, 95% CI 1.3–17.5, p=0.02) and Candida colonization (OR 8.0, 95% CI 2.6–24.9, p<0.001) were identified as independent risk factors. Patients in the IC group had a longer hospital length of stay (p<0.001). There were no differences in beta-D-glucan values, ICU length of stay or disposition between the two groups. Conclusions: Total parenteral nutrition and Candida colonization significantly increased the risk for IC in SICU patients after IAPs.