Intra-Abdominal Candidiasis in Cancer Patients: A 10-Year Experience in a Middle-Income Country

BackgroundInvasive candidiasis (IC) represents a significant threat to both mortality and morbidity, especially among vulnerable populations. Intra-abdominal candidiasis (IAC) frequently occurs in critically ill and cancer patients, with these specific groups carrying a heightened risk for such invasive fungal infections. Despite this, there is a noticeable lack of attention to IAC in cancer patients within the literature, highlighting a critical gap that requires urgent consideration.ObjectivesThis study aimed to explore the clinical and epidemiological characteristics of IAC and identify prognostic factors in a cancer centre in a middle-income country over 10 years.Patients/MethodsA retrospective cohort observational study of adults diagnosed with IAC was conducted at the Instituto do Cancer do Estado de S & atilde;o Paulo (ICESP), a tertiary hospital specialising in oncological diseases with 499 beds, including 85 intensive care unit (ICU) beds, from December 2009 through May 2021.ResultsA total of 128 episodes were included: 67.2% admitted to the ICU; 54.7% males; and median age 62 years. The predominant diagnosis was peritonitis (75.8%). Blood culture samples were collected from 128 patients upon admission, revealing candidemia in 17.2% (22). The most frequently isolated were C. albicans (n = 65, 50.8%) and C. glabrata (n = 42, 32.8%). Antifungal treatment was administered to 91 (71%) patients, with fluconazole (64.8%) and echinocandins (23.4%) being the most common choices. A significant proportion of these patients had a history of abdominal surgery or antibiotic use. Independent factors associated with 30-day mortality included the median Sequential Organ Failure Assessment (SOFA) score of 6 (OR = 1.30, 95% CI 1.094-1.562, p = 0.003), days of treatment (median 10.5) (OR = 0.93, 95% CI 0.870-0.993, p = 0.031) and abdominal source control (78.1%) (OR = 0.148, 95% CI 0.030-0.719, p = 0.018). The 30-day mortality rate was 41.1%.ConclusionsOur study underscores the critical importance of implementing effective source control as a key strategy for reducing mortality in IAC.