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Predictive Factors of Mortality Due to Polymicrobial Peritonitis With Candida Isolation in Peritoneal Fluid in Critically Ill Patients
Hervé Dupont, MD;
Catherine Paugam-Burtz, MD;
Claudette Muller-Serieys, MD;
Lisiane Fierobe, MD;
Denis Chosidow, MD;
Jean-Pierre Marmuse, MD;
Jean Mantz, MD,PhD;
Jean-Marie Desmonts, MD
Arch Surg. 2002;137:1341-1346.
Background Candida peritonitis (CP) is generally considered to be a severe disease, but its impact on outcome in critically ill patients remains unknown.
Hypothesis The predictive factors of mortality due to CP can be determined by study of a population of patients with CP.
Design A retrospective review of a prospective surgical intensive care unit (ICU) database of patients (January 1, 1994, through December 31, 2000).
Setting University hospital in Paris, France.
Patients Eighty-three patients with generalized CP.
Main Outcome Measures Demographic and microbiologic data and outcome were collected, and nonsurvivors were compared with survivors.
Results Overall ICU mortality due to CP was 43 (52%) of 83 patients. In a stepwise multivariate logistic regression, the following 4 variables were independently associated with mortality: APACHE II (Acute Physiology and Chronic Health Evaluation II) score on admission of at least 17 (odds ratio [OR], 28.4; 95% confidence interval [CI], 5.7-142.5; P<.001), respiratory failure on admission (OR, 10.6; 95% CI, 2.2-51.2; P = .003), upper gastrointestinal tract site of peritonitis (OR, 7.7; 95% CI, 1.7-34.7; P = .007), and results of direct examination of peritoneal fluid that were positive for Candida (OR, 4.7; 95% CI, 1.2-19.7; P = .002).
Conclusions These results confirm the severity of CP in ICU patients and emphasize the prognostic value of direct examination of peritoneal fluid for Candida in this context.
From the Departments of Anesthesiology and Surgical Intensive Care Unit (Drs Dupont, Paugam-Burtz, Fierobe, Mantz, and Desmonts), Microbiology (Dr Muller-Serieys), and General Surgery (Drs Chosidow and Marmuse), University Hospital Bichat-Claude Bernard, Paris, France.
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