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Fungal “colonisation” is Associated with Increased Mortality in Medical Intensive Care Unit Patients with Liver Cirrhosis

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Abstract

Objectives

Patients with liver cirrhosis are at increased risk for fungal infections. However, distinction of fungal colonisation (FC) and invasive mycoses is difficult. Aim of this study was to analyse the impact of FC on mortality of cirrhotic ICU-patients.

Methods

Retrospective mortality analysis of a prospectively maintained database on 120 cirrhotic patients with and without FC. Comparison to 120 noncirrhotic controls matched for APACHE-II (24.9 ± 3.7 vs. 25.0 ± 2.6; p = 0.263).

Results

About 69/120 (58 %) of patients with cirrhosis had FC. These patients had significantly higher APACHE-II score and mortality compared to cirrhotic patients without FC (27 ± 3 vs. 23 ± 4, p < 0.001; 78 vs. 35 %, p < 0.001). In multivariate analysis, FC was independently (p = 0.047) associated to mortality. Mortality of noncirrhotic patients with FC (14/31; 45.2 %) was not different to noncirrhotic controls without FC [28/89 (31.2 %; p = 0.168)]. Similarly, in multivariate analysis of noncirrhotics, APACHE-II (p < 0.001), but not FC, was independently associated to mortality. Multiple regression analysis of all 240 cirrhotic and noncirrhotic patients demonstrated that APACHE-II (p < 0.001), cirrhosis (p = 0.001) and FC (p = 0.049) were independently associated with mortality.

Conclusion

Fungal “colonisation” is independently associated to mortality in cirrhotic ICU-patients. Early antimycotic therapy should be considered in critically ill cirrhotic patients with FC.

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References

  1. Donnelly JP. Symptoms and diagnosis of nosocomial fungal infections -state-of-the-art. Eur J Med Res. 2002;31:192–9.

    Google Scholar 

  2. Hsu JL, Ruoss SJ, Bower ND, Lin M, Holodniy M, Stevens DA. Diagnosing invasive fungal disease in critically ill patients. Crit Rev Microbiol. 2011;37:277–312.

    Article  CAS  PubMed  Google Scholar 

  3. Bonnel AR, Bunchorntavakul C, Reddy KR. Immune dysfunction and infections in patients with cirrhosis. Clin Gastroenterol Hepatol. 2011;9:727–38.

    Article  PubMed  Google Scholar 

  4. Tortorano AM, Dho G, Prigitano A, et al. ECMM-FIMUA Study Group invasive fungal infections in the intensive care unit: a multicentre, prospective, observational study in Italy (2006–2008). Mycoses. 2012;55:73–9.

    Article  PubMed  Google Scholar 

  5. Pittet D, Monod M, Suter PM, Frenk E, Auckenthaler R. Candida colonization and subsequent infections in critically ill surgical patients. Ann Surg. 1994;220(6):751–8.

  6. Leroy G, Lambiotte F, Thévenin D, et al. Evaluation of “Candida score” in critically ill patients: a prospective, multicenter, observational, cohort study. Ann Intensive Care. 2011;1(1):50.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Iber FL. Patients with cirrhosis and liver failure are at risk for bacterial and fungus infection. Am J Gastroenterol. 1999;94:2001–3.

    Article  CAS  PubMed  Google Scholar 

  8. Rolando N, Philpott-Howard J, Williams R. Bacterial and fungal infection in acute liver failure. Semin Liver Dis. 1996;16:389–402.

    Article  CAS  PubMed  Google Scholar 

  9. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39(2):165–228.

    Article  CAS  PubMed  Google Scholar 

  10. Kumar A, Safdar N, Kethireddy S, Chateau D. A survival benefit of combination antibiotic therapy for serious infections associated with sepsis and septic shock is contingent only on the risk of death: a meta-analytic/meta-regression study. Crit Care Med. 2010;38(8):1651–64.

    Article  CAS  PubMed  Google Scholar 

  11. O’Brien J, Triantos C, Burroughs AK. Management of varices in patients with cirrhosis. Nat Rev Gastroenterol Hepatol. 2013;10(7):402–12.

    Article  PubMed  Google Scholar 

  12. Gustot T, Durand F, Lebrec D, et al. Severe sepsis in cirrhosis. Hepatology. 2009;50(6):2022–33.

    Article  CAS  PubMed  Google Scholar 

  13. Marchetti O, Eggimann P, Calandra T. Invasive candidiasis in critically ill patients: does progressing knowledge improve clinical management and outcome? Curr Opin Crit Care. 2010;16:442–4.

    Article  PubMed  Google Scholar 

  14. Vazquez JA. Invasive fungal infections in the intensive care unit. Semin Respir Crit Care Med. 2010;31:79–86.

    Article  PubMed  Google Scholar 

  15. Pemán J, Zaragoza R. Current diagnostic approaches to invasive candidiasis in critical care settings. Mycoses. 2010;53:424–33.

    Article  PubMed  Google Scholar 

  16. Choi SH, Soo Kim Y, Chung JW, et al. Clinical significance of untreated Candida species isolated from ascites in cirrhotic patients. Scand J Infect Dis. 2004;9:649–55.

    Article  Google Scholar 

  17. Navasa M, Rimola A, Rodes J. Bacterial infections in liver disease. Semin Liver Dis. 1997;17:323–33.

    Article  CAS  PubMed  Google Scholar 

  18. Yazıcıoğlu Moçin O, Karakurt Z, Aksoy F et al. Bronchoscopy as an indicator of tracheobronchial fungal infection in non-neutropenic intensive-care unit patients. Clin Microbiol Infect. 2013; 19(3):E136–41.

  19. Falcone M, Massetti AP, Russo A, Vullo V, Venditti M. Invasive aspergillosis in patients with liver disease. Med Mycol. 2011;49:406–13.

    Article  PubMed  Google Scholar 

  20. Prodanovic H, Cracco C, Massard J, et al. Invasive pulmonary aspergillosis in patients with decompensated cirrhosis: case series. BMC Gastroenterol. 2007;31:2.

    Article  Google Scholar 

  21. Charles PE, Castro C, Ruiz-Santana S, León C, Saavedra P, Martín E. Serum procalcitonin levels in critically ill patients colonized with Candida spp: new clues for the early recognition of invasive candidiasis? Intensive Care Med. 2009;35:2146–50.

    Article  CAS  PubMed  Google Scholar 

  22. Badiee P, Alborzi A, Joukar M. Molecular assay to detect nosocomial fungal infections in intensive care units. Euro J Intern Med. 2011;22:611–5.

    Article  CAS  Google Scholar 

  23. Badiee P, Alborzi A, Joukar M. Molecular assay to detect nosocomial fungal infections in intensive care units. Eur J Intern Med. 2011;22:611–5.

    Article  CAS  PubMed  Google Scholar 

  24. Lipke AB, Mihas AA. Non-decompensated cirrhosis as a risk factor for invasive aspergillosis: a case report and review of the immune dysfunction of cirrhosis. Am J Med Sci. 2007;334:314–6.

    Article  PubMed  Google Scholar 

  25. Echeverria PM, Kett DH, Azoulay E. Candida prophylaxis and therapy in the ICU. Semin Respir Crit Care Med. 2011;32:159–73.

    Article  PubMed  Google Scholar 

  26. Falcone M, Massetti AP, Russo A, Vullo V, Venditti M. Invasive aspergillosis in patients with liver disease. Med Mycol. 2011;4:406–13.

    Article  Google Scholar 

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Conflict of interest

None of the authors has any potential financial conflict of interest related to this manuscript.

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Authors and Affiliations

  1. II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    Tobias Lahmer, Marlena Messer, Ulrich Mayr, Bernd Saugel, Sebastian Noe, Caroline Schultheiss, Philipp Thies, Christoph Spinner, Simon Nennstiel, Christiane Schwerdtfeger, Veit Phillip, Roland M. Schmid & Wolfgang Huber

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  1. Tobias Lahmer
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  2. Marlena Messer
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  3. Ulrich Mayr
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  4. Bernd Saugel
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  5. Sebastian Noe
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  6. Caroline Schultheiss
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  7. Philipp Thies
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  11. Veit Phillip
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  13. Wolfgang Huber
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Corresponding author

Correspondence to Tobias Lahmer.

Additional information

Tobias Lahmer and Marlena Messer have equally contributed to this article.

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Lahmer, T., Messer, M., Mayr, U. et al. Fungal “colonisation” is Associated with Increased Mortality in Medical Intensive Care Unit Patients with Liver Cirrhosis. Mycopathologia 179, 63–71 (2015). https://doi.org/10.1007/s11046-014-9825-6

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  • DOI: https://doi.org/10.1007/s11046-014-9825-6

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