Fungal “colonisation” is Associated with Increased Mortality in Medical Intensive Care Unit Patients with Liver Cirrhosis
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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.
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).
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.
Fungal “colonisation” is independently associated to mortality in cirrhotic ICU-patients. Early antimycotic therapy should be considered in critically ill cirrhotic patients with FC.
KeywordsFungal colonisation Liver cirrhosis Critical ill patients Invasive mycoses
Conflict of interest
None of the authors has any potential financial conflict of interest related to this manuscript.
- 1.Donnelly JP. Symptoms and diagnosis of nosocomial fungal infections -state-of-the-art. Eur J Med Res. 2002;31:192–9.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.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.PubMedCrossRefGoogle 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.Google Scholar