Abstract
Background: The delayed diagnosis of the presence of Candida in severe intra-abdominal infections exposes patients to an increased risk of mortality. The prevalence of intra-abdominal candidiasis (IAC) varies with the type of intra-abdominal infection, the underlying conditions and the presence of risk factors for Candida infection. This study aims to evaluate the interest of the measure of 1.3-β-D-glucan (BDG) in the peritoneal fluid for the early diagnosis of IAC. Methods and analysis: This is a prospective multicenter (n = 5) non-interventional study, focusing on all critically ill patients with an intra-abdominal infection requiring intra-abdominal surgery. The primary objective is to assess the diagnostic performance of the BDG measured in the peritoneal fluid for the early detection of IAC using the Candida culture as the gold standard. The secondary objective is to report the prevalence of IAC in the selected population. This study aims to enroll 200 patients within 48 months. By estimating the prevalence of IAC in the selected population at 30%, 50 patients with IAC (cases) are expected. These 50 IAC cases will be matched with 50 non-IAC patients (as a control group). The peritoneal BDG will be measured a posteriori in all of these 100 selected patients. This article presents the protocol and the current status of the study. Only the prevalence of IAC is reported as preliminary result.
Highlights
In a narrative review on intra-abdominal infection, the European Society of Intensive Care Medicine highlighted the “peculiar challenges” regarding fungal infections and the “need for more solid evidence to firmly guide the use of rapid fungal diagnostics” [1].Because of the heterogeneity in patient characteristics, clinical presentations and therapeutic management, intra-abdominal infections are not well defined
Regarding fungal infections in this setting, the term intra-abdominal candidiasis (IAC) is widely used and is defined by sterilely collected peritoneal fluid (PF) cultures that are positive for Candida spp., as determined by the signs and symptoms consistent with an active infection [2]
The secondary objectives are (i) to measure the prevalence of IAC in critically ill patients with Candida risk factors and an intra-abdominal infection requiring an abdominal surgery, (ii) to identify the risk factors for IAC, (iii) to assess the diagnostic performance of the biomarkers such as serum 1.3-β-D-glucan (BDG) measured in the PF for early detection of IAC using Candida culture as the gold standard and (iv) to compare peritoneal and serum BDG in the same patient
Summary
In a narrative review on intra-abdominal infection, the European Society of Intensive Care Medicine highlighted the “peculiar challenges” regarding fungal infections and the “need for more solid evidence to firmly guide the use of rapid fungal diagnostics” [1].Because of the heterogeneity in patient characteristics, clinical presentations and therapeutic management, intra-abdominal infections are not well defined. Considered to be the most common type of invasive candidiasis in critically ill patients [3], IAC is associated with mortality rates of approximately 25–60% [4,5] This high variability in mortality could be explained by the heterogeneity of studying populations [3]. The decision to start an empirical antifungal treatment is based on predictive scores such as the Candida score [8], the Candida colonization index [9] or the peritonitis score [10] These scores must be integrated in a global evaluation of risk factors and the patient’s underlying conditions. The prevalence of intra-abdominal candidiasis (IAC) varies with the type of intra-abdominal infection, the underlying conditions and the presence of risk factors for Candida infection.
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