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Predictive Factors of Mortality Due to Polymicrobial Peritonitis With Candida Isolation in Peritoneal Fluid in Critically Ill Patients—Invited Critique
Joseph S. Solomkin, MD
Cincinnati, Ohio
Arch Surg. 2002;137:1347.
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One of the more perplexing problems in the management of disease in patients with intra-abdominal infections is whether to provide empirical anti-infective therapy for the wide range of microorganisms that are commonly encountered in such patients. This debate is usually phrased in terms of the pathogenicity of specific microorganisms. A retrospective study1 of patients with postoperative peritonitis found that empirical antibiotic therapy that was not active against all of the bacterial species subsequently shown to be present resulted in higher failure rates, which were defined as either mortality or need for reoperation. This conclusion was supported by retrospective analyses2 of other infections. However, the pathogenicity of Candida species has been debated, particularly when Candida has been identified in community-acquired infections. The study by Dupont and colleagues, which looked at correlates of mortality by using multiple logistic regression, found that results of direct (microscopic) examination of peritoneal . . . [Full Text of this Article]
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