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MINERVA ANESTESIOLOGICA

A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2017 May 11

DOI: 10.23736/S0375-9393.17.11528-2

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Elderly versus non-elderly patients with intra-abdominal candidiasis in the ICU

George DIMOPOULOS 1 , Dimitrios K. MATTHAIOU 1, Elda RIGHI 2, Maria MERELLI 2, Matteo BASSETTI 2

1 Department of Critical Care Medicine, Attikon University Hospital, University of Athens, Medical School, Athens, Greece; 2 Infectious Diseases Clinic, Santa Maria Misericordia University Hospital, Udine, Italy


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BACKGROUND: Intra-abdominal candidiasis (IAC) has a considerable cost in terms of mortality and morbidity. We sought to study the epidemiology, characteristics and outcome of elderly (>75 years old) versus non-elderly patients with IAC and risk factors for mortality in elderly patients.
METHODS: Post-hoc analysis of a retrospective multinational cohort study over a 3- year period (2011-2013).
RESULTS: Of 482 patients, 124 (25.7%) were elderly and 358 (74.3%) were non- elderly. The mean age was 80.4±3.9 and 56.3±13.8 years, respectively. Fifty-four of 124 (43.5%) and 75/358 (20.9%) died until the end of observation. The majority of isolates were Candida albicans. Echinocandins were the most prescribed initial agent. Elderly patients were more likely to have a higher APACHE II score, and to suffer from COPD and heart disease. Non-elderly patients were more likely to be treated with immunosuppressants and steroids, and to have received a solid organ transplantation. Mortality was significantly higher in the elderly group. Regarding risk factors for mortality in elderly patients, non-survivors were more likely to be males, reoperated, develop septic shock, receive vasopressors, suffer from end stage renal disease (ESRD), and have inadequate abdominal source control within 48 hours. They had a higher APACHE II score and a higher number of acquired organ dysfunction. ESRD and inadequate abdominal source control were significantly associated with mortality.
CONCLUSIONS: Factors independently predicting mortality in elderly patients with IAC were ESRD and inadequate abdominal source control. Elderlies were found to have more pulmonary and cardiac morbidities and had higher mortality than non-elderlies.


KEY WORDS: Candida spp. infection - β-D-glucan - Elderly - Geriatric - Intra-abdominal

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gdimop@med.uoa.gr