Early invasive fungal infections and colonization in patients with cirrhosis admitted to the intensive care unit
Bacterial infections in cirrhosis are common and associated with increased mortality, but little is known about fungal infections. The aim of this study, a sub-analysis of the Fungal Infection Risk Evaluation study, was to assess the incidence and implications of early invasive fungal disease (IFD)...
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| Veröffentlicht in: | Clinical microbiology and infection 2016-02, Vol.22 (2), p.189.e1-189.e7 |
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| container_title | Clinical microbiology and infection |
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| creator | Theocharidou, E. Agarwal, B. Jeffrey, G. Jalan, R. Harrison, D. Burroughs, A.K. Kibbler, C.C. |
| description | Bacterial infections in cirrhosis are common and associated with increased mortality, but little is known about fungal infections. The aim of this study, a sub-analysis of the Fungal Infection Risk Evaluation study, was to assess the incidence and implications of early invasive fungal disease (IFD) in patients with cirrhosis admitted to intensive care units (ICU). Clinical and laboratory parameters collected in the first 3 days of ICU stay for 782 patients with cirrhosis and/or portal hypertension were analysed and compared with those of 273 patients with very severe cardiovascular disease (CVD). The CVD patients had more co-morbidities and higher APACHE II scores. The overall incidence of IFD was similar in the two groups, but the incidence of IFD in ICU was higher in liver patients (1% versus 0.4%; p 0.025) as was fungal colonization (23.8% versus 13.9%; p 0.001). The ICU and in-hospital mortality, and length of stay were similar in the two groups. A higher proportion of liver patients received antifungal therapy (19.2% versus 7%; p |
| doi_str_mv | 10.1016/j.cmi.2015.10.020 |
| format | Article |
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The aim of this study, a sub-analysis of the Fungal Infection Risk Evaluation study, was to assess the incidence and implications of early invasive fungal disease (IFD) in patients with cirrhosis admitted to intensive care units (ICU). Clinical and laboratory parameters collected in the first 3 days of ICU stay for 782 patients with cirrhosis and/or portal hypertension were analysed and compared with those of 273 patients with very severe cardiovascular disease (CVD). The CVD patients had more co-morbidities and higher APACHE II scores. The overall incidence of IFD was similar in the two groups, but the incidence of IFD in ICU was higher in liver patients (1% versus 0.4%; p 0.025) as was fungal colonization (23.8% versus 13.9%; p 0.001). The ICU and in-hospital mortality, and length of stay were similar in the two groups. A higher proportion of liver patients received antifungal therapy (19.2% versus 7%; p <0.0005). There was no difference in mortality between colonized patients who received antifungal therapy and colonized patients who did not. The incidence of IFD in patients with cirrhosis in ICU is higher compared with another high-risk group, although it is still very low. This risk might be higher in patients with advanced liver disease admitted with acute-on-chronic liver failure, and this should be investigated further. Our data do not support prophylactic use of antifungal therapy in cirrhosis.</description><identifier>ISSN: 1198-743X</identifier><identifier>EISSN: 1469-0691</identifier><identifier>DOI: 10.1016/j.cmi.2015.10.020</identifier><identifier>PMID: 26551838</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Cardiovascular Diseases - microbiology ; Cardiovascular Diseases - mortality ; Cirrhosis ; colonization ; Female ; fungal infections ; Hospital Mortality ; Humans ; Hypertension, Portal - microbiology ; Hypertension, Portal - mortality ; Incidence ; intensive care unit ; Intensive Care Units ; Length of Stay ; Liver Cirrhosis - microbiology ; Liver Cirrhosis - mortality ; liver disease ; Male ; Middle Aged ; mortality ; Mycoses - epidemiology ; Young Adult</subject><ispartof>Clinical microbiology and infection, 2016-02, Vol.22 (2), p.189.e1-189.e7</ispartof><rights>2015 European Society of Clinical Microbiology and Infectious Diseases</rights><rights>Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c466t-38f80c10084022070922aa28a30df5eb3cf4db8e27a09a6231901ba59947bd8a3</citedby><cites>FETCH-LOGICAL-c466t-38f80c10084022070922aa28a30df5eb3cf4db8e27a09a6231901ba59947bd8a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26551838$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Theocharidou, E.</creatorcontrib><creatorcontrib>Agarwal, B.</creatorcontrib><creatorcontrib>Jeffrey, G.</creatorcontrib><creatorcontrib>Jalan, R.</creatorcontrib><creatorcontrib>Harrison, D.</creatorcontrib><creatorcontrib>Burroughs, A.K.</creatorcontrib><creatorcontrib>Kibbler, C.C.</creatorcontrib><title>Early invasive fungal infections and colonization in patients with cirrhosis admitted to the intensive care unit</title><title>Clinical microbiology and infection</title><addtitle>Clin Microbiol Infect</addtitle><description>Bacterial infections in cirrhosis are common and associated with increased mortality, but little is known about fungal infections. The aim of this study, a sub-analysis of the Fungal Infection Risk Evaluation study, was to assess the incidence and implications of early invasive fungal disease (IFD) in patients with cirrhosis admitted to intensive care units (ICU). Clinical and laboratory parameters collected in the first 3 days of ICU stay for 782 patients with cirrhosis and/or portal hypertension were analysed and compared with those of 273 patients with very severe cardiovascular disease (CVD). The CVD patients had more co-morbidities and higher APACHE II scores. The overall incidence of IFD was similar in the two groups, but the incidence of IFD in ICU was higher in liver patients (1% versus 0.4%; p 0.025) as was fungal colonization (23.8% versus 13.9%; p 0.001). The ICU and in-hospital mortality, and length of stay were similar in the two groups. A higher proportion of liver patients received antifungal therapy (19.2% versus 7%; p <0.0005). There was no difference in mortality between colonized patients who received antifungal therapy and colonized patients who did not. The incidence of IFD in patients with cirrhosis in ICU is higher compared with another high-risk group, although it is still very low. This risk might be higher in patients with advanced liver disease admitted with acute-on-chronic liver failure, and this should be investigated further. Our data do not support prophylactic use of antifungal therapy in cirrhosis.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cardiovascular Diseases - microbiology</subject><subject>Cardiovascular Diseases - mortality</subject><subject>Cirrhosis</subject><subject>colonization</subject><subject>Female</subject><subject>fungal infections</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Hypertension, Portal - microbiology</subject><subject>Hypertension, Portal - mortality</subject><subject>Incidence</subject><subject>intensive care unit</subject><subject>Intensive Care Units</subject><subject>Length of Stay</subject><subject>Liver Cirrhosis - microbiology</subject><subject>Liver Cirrhosis - mortality</subject><subject>liver disease</subject><subject>Male</subject><subject>Middle Aged</subject><subject>mortality</subject><subject>Mycoses - epidemiology</subject><subject>Young Adult</subject><issn>1198-743X</issn><issn>1469-0691</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMtuHCEQRVGUKH5-QDYRy2x6XEA_aHkVWX5JlrxJpOwQDdUZRt0wAXoi--vDeOwsvaKqOHWlOoR8YbBiwNqLzcrMbsWBNaVfAYcP5JjVbV9B27OPpWa9rLpa_DoiJyltAIALUX8mR7xtGiaFPCbbax2nJ-r8Tie3Qzou_reeSj-iyS74RLW31IQpePes95PyR7elQp8T_evymhoX4zokV1g7u5zR0hxoXmNBM_qXXKMj0sW7fEY-jXpKeP76npKfN9c_ru6qh8fb-6vvD5Wp2zZXQo4SDAOQNXAOHfSca82lFmDHBgdhxtoOEnmnodctF6wHNuim7-tusAU7Jd8OudsY_iyYsppdMjhN2mNYkmJdcSCZkLKg7ICaGFKKOKptdLOOT4qB2otWG1VEq73o_aiILjtfX-OXYUb7f-PNbAEuDwCWI3cOo0qmODNoXSxqlQ3unfh_hCyPog</recordid><startdate>20160201</startdate><enddate>20160201</enddate><creator>Theocharidou, E.</creator><creator>Agarwal, B.</creator><creator>Jeffrey, G.</creator><creator>Jalan, R.</creator><creator>Harrison, D.</creator><creator>Burroughs, A.K.</creator><creator>Kibbler, C.C.</creator><general>Elsevier Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160201</creationdate><title>Early invasive fungal infections and colonization in patients with cirrhosis admitted to the intensive care unit</title><author>Theocharidou, E. ; Agarwal, B. ; Jeffrey, G. ; Jalan, R. ; Harrison, D. ; Burroughs, A.K. ; Kibbler, C.C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c466t-38f80c10084022070922aa28a30df5eb3cf4db8e27a09a6231901ba59947bd8a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cardiovascular Diseases - microbiology</topic><topic>Cardiovascular Diseases - mortality</topic><topic>Cirrhosis</topic><topic>colonization</topic><topic>Female</topic><topic>fungal infections</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Hypertension, Portal - microbiology</topic><topic>Hypertension, Portal - mortality</topic><topic>Incidence</topic><topic>intensive care unit</topic><topic>Intensive Care Units</topic><topic>Length of Stay</topic><topic>Liver Cirrhosis - microbiology</topic><topic>Liver Cirrhosis - mortality</topic><topic>liver disease</topic><topic>Male</topic><topic>Middle Aged</topic><topic>mortality</topic><topic>Mycoses - epidemiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Theocharidou, E.</creatorcontrib><creatorcontrib>Agarwal, B.</creatorcontrib><creatorcontrib>Jeffrey, G.</creatorcontrib><creatorcontrib>Jalan, R.</creatorcontrib><creatorcontrib>Harrison, D.</creatorcontrib><creatorcontrib>Burroughs, A.K.</creatorcontrib><creatorcontrib>Kibbler, C.C.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical microbiology and infection</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Theocharidou, E.</au><au>Agarwal, B.</au><au>Jeffrey, G.</au><au>Jalan, R.</au><au>Harrison, D.</au><au>Burroughs, A.K.</au><au>Kibbler, C.C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early invasive fungal infections and colonization in patients with cirrhosis admitted to the intensive care unit</atitle><jtitle>Clinical microbiology and infection</jtitle><addtitle>Clin Microbiol Infect</addtitle><date>2016-02-01</date><risdate>2016</risdate><volume>22</volume><issue>2</issue><spage>189.e1</spage><epage>189.e7</epage><pages>189.e1-189.e7</pages><issn>1198-743X</issn><eissn>1469-0691</eissn><abstract>Bacterial infections in cirrhosis are common and associated with increased mortality, but little is known about fungal infections. The aim of this study, a sub-analysis of the Fungal Infection Risk Evaluation study, was to assess the incidence and implications of early invasive fungal disease (IFD) in patients with cirrhosis admitted to intensive care units (ICU). Clinical and laboratory parameters collected in the first 3 days of ICU stay for 782 patients with cirrhosis and/or portal hypertension were analysed and compared with those of 273 patients with very severe cardiovascular disease (CVD). The CVD patients had more co-morbidities and higher APACHE II scores. The overall incidence of IFD was similar in the two groups, but the incidence of IFD in ICU was higher in liver patients (1% versus 0.4%; p 0.025) as was fungal colonization (23.8% versus 13.9%; p 0.001). The ICU and in-hospital mortality, and length of stay were similar in the two groups. A higher proportion of liver patients received antifungal therapy (19.2% versus 7%; p <0.0005). There was no difference in mortality between colonized patients who received antifungal therapy and colonized patients who did not. The incidence of IFD in patients with cirrhosis in ICU is higher compared with another high-risk group, although it is still very low. This risk might be higher in patients with advanced liver disease admitted with acute-on-chronic liver failure, and this should be investigated further. Our data do not support prophylactic use of antifungal therapy in cirrhosis.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>26551838</pmid><doi>10.1016/j.cmi.2015.10.020</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Cardiovascular Diseases - microbiology Cardiovascular Diseases - mortality Cirrhosis colonization Female fungal infections Hospital Mortality Humans Hypertension, Portal - microbiology Hypertension, Portal - mortality Incidence intensive care unit Intensive Care Units Length of Stay Liver Cirrhosis - microbiology Liver Cirrhosis - mortality liver disease Male Middle Aged mortality Mycoses - epidemiology Young Adult |
| title | Early invasive fungal infections and colonization in patients with cirrhosis admitted to the intensive care unit |
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