European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2025
Temporal changes in fungal epidemiology in ICU post-operative peritonitis cases.
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Montravers Philippe, Bonnal Christine, Andrei Stefan, Augustin Pascal, Grall Nathalie, Zappella Nathalie
Аннотация
PURPOSE: Recent changes in the mycological profile have been reported in several life-threatening infections, but no data have assessed this issue in postoperative peritonitis (POP).
METHODS: This retrospective monocentric analysis (1999-2019) evaluated the temporal changes of fungi collected from POP samples in intensive care unit (ICU) patients and assessed the adequacy of antifungal therapy (AFT) and the prognosis.
RESULTS: Overall, 1,389 microorganisms were cultured from surgical samples in 464 ICU patients, including 186 (40%) patients harbouring fungi (11 fungaemia). Growing proportions of fungi were observed over time (p < 0.01), related to increased rates of Candida albicans and C. non-albicans (p = 0.01 and p < 0.01, respectively). A significantly increased prescription of empirical AFT was observed during the study period (p < 0.0001). Adequate empirical AFT was achieved in 93/186 (50%) patients in the fungal group. Documented AFT was given in 163/174 (94%) patients in the fungal group for a median duration of 14 [9-21] days, mainly with fluconazole. The ICU and hospital mortality rates were similar in bacterial and fungal groups. However, we observed a significant increase in the duration of mechanical ventilation and ICU stay in the fungal group.
CONCLUSION: We observed high and growing proportions of fungi in patients treated for POP associated to increasing proportions of both C. albicans and C. non-albicans. Adequate AFT was achieved in all cases with caspofungin, but fluconazole remains an acceptable option for de-escalation. Our data suggest that, in ICU patients with POP, the severity of illness, rather than adequate AFT, drives clinical outcomes.
METHODS: This retrospective monocentric analysis (1999-2019) evaluated the temporal changes of fungi collected from POP samples in intensive care unit (ICU) patients and assessed the adequacy of antifungal therapy (AFT) and the prognosis.
RESULTS: Overall, 1,389 microorganisms were cultured from surgical samples in 464 ICU patients, including 186 (40%) patients harbouring fungi (11 fungaemia). Growing proportions of fungi were observed over time (p < 0.01), related to increased rates of Candida albicans and C. non-albicans (p = 0.01 and p < 0.01, respectively). A significantly increased prescription of empirical AFT was observed during the study period (p < 0.0001). Adequate empirical AFT was achieved in 93/186 (50%) patients in the fungal group. Documented AFT was given in 163/174 (94%) patients in the fungal group for a median duration of 14 [9-21] days, mainly with fluconazole. The ICU and hospital mortality rates were similar in bacterial and fungal groups. However, we observed a significant increase in the duration of mechanical ventilation and ICU stay in the fungal group.
CONCLUSION: We observed high and growing proportions of fungi in patients treated for POP associated to increasing proportions of both C. albicans and C. non-albicans. Adequate AFT was achieved in all cases with caspofungin, but fluconazole remains an acceptable option for de-escalation. Our data suggest that, in ICU patients with POP, the severity of illness, rather than adequate AFT, drives clinical outcomes.