Risk Factors for Developing Candidemia after Gastrointestinal Perforation and/or Ischemia and Its Outcomes: A Matched Case-Control Study.

IF 1.4 4区医学 Q4 INFECTIOUS DISEASES

Surgical infections Pub Date : 2026-04-23 DOI:10.1177/10962964261445330

Myeongji Kim, Nischal Ranganath, Sofia Molina Garcia, Kemar O Barrett, Khalid H Mahmoud, Ryan W Stevens, Allison M LeMahieu, Veljko Strajina, Aditya Shah

{"title":"Risk Factors for Developing Candidemia after Gastrointestinal Perforation and/or Ischemia and Its Outcomes: A Matched Case-Control Study.","authors":"Myeongji Kim, Nischal Ranganath, Sofia Molina Garcia, Kemar O Barrett, Khalid H Mahmoud, Ryan W Stevens, Allison M LeMahieu, Veljko Strajina, Aditya Shah","doi":"10.1177/10962964261445330","DOIUrl":null,"url":null,"abstract":"Background: Candidemia is a serious complication after gastrointestinal (GI) perforation and/or ischemia, yet most evidence pools candidemia with intra-abdominal candidiasis (IAC). We sought candidemia-specific risk factors after GI perforation and/or ischemia and evaluated associated outcomes.Methods: We conducted a single-center, retrospective matched case-control study of adults undergoing emergency surgical procedure for GI perforation and/or ischemia and admitted to a surgical intensive care unit. Cases with candidemia during index admission were matched 4:1 to controls by age, Charlson Comorbidity Index, and surgical procedure year. Conditional logistic regression assessed pre-specified risk factors, and exploratory outcomes included mortality, length of stay, and days on invasive ventilation.Results: Twenty-four cases were matched to 99 controls. Factors identified to be independently associated with candidemia include the presence of IAC (adjusted OR [aOR]: 5.51, 95% CI: 1.61, 18.89; p = 0.007), upper GI injury (aOR: 4.28, 95% CI: 1.52-12.08; p = 0.006), and diffuse intra-abdominal contamination, compared with contained/none (aOR: 3.21, 95% CI: 1.06-9.74; p = 0.040). Among candidemia cases, species distribution was Candida albicans 41.7%, C. glabrata 33.3%, C. parapsilosis 12.5%, with single cases of C. tropicalis, C. krusei, and C. dubliniensis. Candidemia was associated with a longer hospital length of stay (+13.97 d; 95% CI: 0.90-27.04; p = 0.036), without significant differences in ICU stay, duration of invasive ventilation, or mortality.Conclusions: After GI perforation and/or ischemia, the risk of candidemia is highest in patients with upper GI injury and diffuse contamination, independent of IAC. These readily identifiable operative features may guide targeted surveillance and selective early antifungal strategies. Prospective validation is warranted.","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"10962964261445330"},"PeriodicalIF":1.4000,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgical infections","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/10962964261445330","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Candidemia is a serious complication after gastrointestinal (GI) perforation and/or ischemia, yet most evidence pools candidemia with intra-abdominal candidiasis (IAC). We sought candidemia-specific risk factors after GI perforation and/or ischemia and evaluated associated outcomes.

Methods: We conducted a single-center, retrospective matched case-control study of adults undergoing emergency surgical procedure for GI perforation and/or ischemia and admitted to a surgical intensive care unit. Cases with candidemia during index admission were matched 4:1 to controls by age, Charlson Comorbidity Index, and surgical procedure year. Conditional logistic regression assessed pre-specified risk factors, and exploratory outcomes included mortality, length of stay, and days on invasive ventilation.

Results: Twenty-four cases were matched to 99 controls. Factors identified to be independently associated with candidemia include the presence of IAC (adjusted OR [aOR]: 5.51, 95% CI: 1.61, 18.89; p = 0.007), upper GI injury (aOR: 4.28, 95% CI: 1.52-12.08; p = 0.006), and diffuse intra-abdominal contamination, compared with contained/none (aOR: 3.21, 95% CI: 1.06-9.74; p = 0.040). Among candidemia cases, species distribution was Candida albicans 41.7%, C. glabrata 33.3%, C. parapsilosis 12.5%, with single cases of C. tropicalis, C. krusei, and C. dubliniensis. Candidemia was associated with a longer hospital length of stay (+13.97 d; 95% CI: 0.90-27.04; p = 0.036), without significant differences in ICU stay, duration of invasive ventilation, or mortality.

Conclusions: After GI perforation and/or ischemia, the risk of candidemia is highest in patients with upper GI injury and diffuse contamination, independent of IAC. These readily identifiable operative features may guide targeted surveillance and selective early antifungal strategies. Prospective validation is warranted.

查看原文本刊更多论文

胃肠道穿孔和/或缺血后念珠菌病发生的危险因素及其结果：一项匹配的病例对照研究

背景：念珠菌病是胃肠道（GI）穿孔和/或缺血后的严重并发症，但大多数证据表明念珠菌病与腹腔内念珠菌病（IAC）有关。我们在胃肠道穿孔和/或缺血后寻找念珠菌特异性危险因素，并评估相关结果。方法：我们进行了一项单中心、回顾性匹配的病例对照研究，研究对象是因胃肠道穿孔和/或缺血接受紧急外科手术并入住外科重症监护病房的成年人。根据年龄、Charlson合并症指数和手术年份，入院时念珠菌感染病例与对照组的比例为4:1。条件逻辑回归评估了预先指定的危险因素，探索性结果包括死亡率、住院时间和有创通气天数。结果：24例与99例对照吻合。与念菌血症独立相关的因素包括IAC的存在（调整后的OR [aOR]: 5.51, 95% CI: 1.61, 18.89; p = 0.007），上消化道损伤（aOR: 4.28, 95% CI: 1.52-12.08; p = 0.006），以及腹内弥漫性污染（aOR: 3.21, 95% CI: 1.06-9.74; p = 0.040）。念珠菌种类分布以白色念珠菌41.7%、光秃念珠菌33.3%、假丝念珠菌12.5%为主，热带念珠菌、克鲁塞念珠菌、都柏林念珠菌为单例。念珠菌与较长的住院时间相关（+13.97 d; 95% CI: 0.90-27.04; p = 0.036），在ICU住院时间、有创通气时间或死亡率方面无显著差异。结论：在胃肠道穿孔和/或缺血后，念珠菌血症的风险在上消化道损伤和弥漫性污染患者中最高，与IAC无关。这些易于识别的操作特征可以指导有针对性的监测和选择性的早期抗真菌策略。前瞻性验证是必要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Surgical infections INFECTIOUS DISEASES-SURGERY

CiteScore

3.80

自引率

5.00%

发文量

127

审稿时长

6-12 weeks

期刊介绍： Surgical Infections provides comprehensive and authoritative information on the biology, prevention, and management of post-operative infections. Original articles cover the latest advancements, new therapeutic management strategies, and translational research that is being applied to improve clinical outcomes and successfully treat post-operative infections. Surgical Infections coverage includes: -Peritonitis and intra-abdominal infections- Surgical site infections- Pneumonia and other nosocomial infections- Cellular and humoral immunity- Biology of the host response- Organ dysfunction syndromes- Antibiotic use- Resistant and opportunistic pathogens- Epidemiology and prevention- The operating room environment- Diagnostic studies