Analysis of 15 cases from a monocentric cohort of 307 liver abscesses.
Candida liver abscess
recurrence
Journal
Mycoses
ISSN: 1439-0507
Titre abrégé: Mycoses
Pays: Germany
ID NLM: 8805008
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
revised:
06
07
2023
received:
06
06
2023
accepted:
25
07
2023
medline:
4
10
2023
pubmed:
3
8
2023
entrez:
3
8
2023
Statut:
ppublish
Résumé
Out of the context of haematological patients, Candida sp. is rarely retrieved from pyogenic liver abscesses (PLA). Our objective was to assess the risk factors for occurrence, and clinical, microbiological characteristics, management and outcome of Candida pyogenic liver abscesses (C-PLA). We retrospectively analysed C-PLA cases and compared them to pyogenic liver abscesses exclusively due to bacteria (B-PLA) included in our monocentric database on liver abscesses. Unfavourable course was defined as the occurrence of a primary treatment failure (PTF), recurrence after an initial cure, or death within 3 months after diagnosis. Between 2010 and 2018, 15 C-PLA and 292 B-PLA were included. All C-PLA had a biliary origin and were polymicrobial. All patients with C-PLA had at least one comorbidity at risk for Candida infection and 7 (53.3%) presented with sepsis requiring an admission in intensive care unit. Median duration of antifungal treatment was 42 days [24-55]. In multivariate analysis, compared with B-PLA, a medical history of malignancy (OR 4.16; 95%CI 1.15-18.72) or liver abscess (OR 7.39; 95%CI 2.10-26.62), and sepsis with severity criteria (OR 3.52; 95%CI 1.07-11.90) were independently associated with the occurrence of C-PLA. In multivariate analysis, C-PLA was associated with a higher risk of recurrence (HR 3.08; 95%CI 1.38-11.22). Candida liver abscesses in non-neutropenic is a rare and severe disease. The high rate of recurrence should lead to discuss a more intensive treatment.
Sections du résumé
BACKGROUND
BACKGROUND
Out of the context of haematological patients, Candida sp. is rarely retrieved from pyogenic liver abscesses (PLA).
OBJECTIVES
OBJECTIVE
Our objective was to assess the risk factors for occurrence, and clinical, microbiological characteristics, management and outcome of Candida pyogenic liver abscesses (C-PLA).
PATIENTS/METHODS
METHODS
We retrospectively analysed C-PLA cases and compared them to pyogenic liver abscesses exclusively due to bacteria (B-PLA) included in our monocentric database on liver abscesses. Unfavourable course was defined as the occurrence of a primary treatment failure (PTF), recurrence after an initial cure, or death within 3 months after diagnosis.
RESULTS
RESULTS
Between 2010 and 2018, 15 C-PLA and 292 B-PLA were included. All C-PLA had a biliary origin and were polymicrobial. All patients with C-PLA had at least one comorbidity at risk for Candida infection and 7 (53.3%) presented with sepsis requiring an admission in intensive care unit. Median duration of antifungal treatment was 42 days [24-55]. In multivariate analysis, compared with B-PLA, a medical history of malignancy (OR 4.16; 95%CI 1.15-18.72) or liver abscess (OR 7.39; 95%CI 2.10-26.62), and sepsis with severity criteria (OR 3.52; 95%CI 1.07-11.90) were independently associated with the occurrence of C-PLA. In multivariate analysis, C-PLA was associated with a higher risk of recurrence (HR 3.08; 95%CI 1.38-11.22).
CONCLUSION
CONCLUSIONS
Candida liver abscesses in non-neutropenic is a rare and severe disease. The high rate of recurrence should lead to discuss a more intensive treatment.
Substances chimiques
Polyesters
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
984-991Informations de copyright
© 2023 Wiley-VCH GmbH. Published by John Wiley & Sons Ltd.
Références
Fiore M, Cascella M, Bimonte S, et al. Liver fungal infections: an overview of the etiology and epidemiology in patients affected or not affected by oncohematologic malignancies. Infect Drug Resist. 2018;11:177-186. doi:10.2147/IDR.S152473
Lewis JH, Patel HR, Zimmerman HJ. The spectrum of hepatic candidiasis. Hepatology. 1982;2(4):479-487. doi:10.1002/hep.1840020415
Chen CY, Cheng A, Tien FM, et al. Chronic disseminated candidiasis manifesting as hepatosplenic abscesses among patients with hematological malignancies. BMC Infect Dis. 2019;19(1):635. doi:10.1186/s12879-019-4260-4
Wade JJ, Rolando N, Hayllar K, Philpott-Howard J, Casewell MW, Williams R. Bacterial and fungal infections after liver transplantation: an analysis of 284 patients. Hepatology. 1995;21(5):1328-1336. doi:10.1002/hep.1840210517
Petri A, Höhn J, Hódi Z, Wolfárd A, Balogh A. Pyogenic liver abscess - 20 years' experience. Comparison of results of treatment in two periods. Langenbecks Arch Surg. 2002;387(1):27-31. doi:10.1007/s00423-002-0279-9
Huang CJ, Pitt HA, Lipsett PA, et al. Pyogenic hepatic abscess. Changing trends over 42 years. Ann Surg. 1996;223(5):600-609. doi:10.1097/00000658-199605000-00016
Seeto RK, Rockey DC. Pyogenic liver abscess. Changes in etiology, management, and outcome. Medicine. 1996;75(2):99-113. doi:10.1097/00005792-199603000-00006
Rahimian J, Wilson T, Oram V, Holzman RS. Pyogenic liver abscess: recent trends in etiology and mortality. Clin Infect Dis. 2004;39(11):1654-1659. doi:10.1086/425616
Lipsett PA, Huang CJ, Lillemoe KD, Cameron JL, Pitt HA. Fungal hepatic abscesses: characterization and management. J Gastrointest Surg. 1997;1(1):78-84. doi:10.1007/s11605-006-0013-y
Khardori N, Wong E, Carrasco CH, Wallace S, Patt Y, Bodey GP. Infections associated with biliary drainage procedures in patients with cancer. Rev Infect Dis. 1991;13(4):587-591. doi:10.1093/clinids/13.4.587
Lai CH, Chen HP, Chen TL, Fung CP, Liu CY, Lee SD. Candidal liver abscesses and cholecystitis in a 37-year-old patient without underlying malignancy. World J Gastroenterol. 2005;11(11):1725-1727. doi:10.3748/wjg.v11.i11.1725
Melero JL, Bastida G, Yago M, Nevárez A, Nos P, Ponce J. Fungal liver abscesses in a patient with primary sclerosing cholangitis and Crohn's disease. Gastroenterol Hepatol. 2008;31(9):576-579. doi:10.1157/13128297
Rossi G, Nguyen Y, Lafont E, et al. Large retrospective study analysing predictive factors of primary treatment failure, recurrence and death in pyogenic liver abscesses. Infection. 2022;50(5):1205-1215. doi:10.1007/s15010-022-01793-z
Lardière-Deguelte S, Ragot E, Amroun K, et al. Hepatic abscess: diagnosis and management. J Visc Surg. 2015;152(4):231-243. doi:10.1016/j.jviscsurg.2015.01.013
Rossi G, Lafont E, Gasperini L, et al. Liver abscess. Rev Med Interne. 2016;37(12):827-833. doi:10.1016/j.revmed.2016.08.009
Roediger R, Lisker-Melman M. Pyogenic and amebic infections of the liver. Gastroenterol Clin North Am. 2020;49(2):361-377. doi:10.1016/j.gtc.2020.01.013
Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801-810. doi:10.1001/jama.2016.0287
EUCAST: EUCAST. Accessed November 23, 2021. https://www.eucast.org/
Almirante B, Rodríguez D, Park BJ, et al. Epidemiology and predictors of mortality in cases of Candida bloodstream infection: results from population-based surveillance, Barcelona, Spain, from 2002 to 2003. J Clin Microbiol. 2005;43(4):1829-1835. doi:10.1128/JCM.43.4.1829-1835.2005
Lortholary O, Renaudat C, Sitbon K, et al. Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002-2010). Intensive Care Med. 2014;40(9):1303-1312. doi:10.1007/s00134-014-3408-3
Domagk D, Fegeler W, Conrad B, Menzel J, Domschke W, Kucharzik T. Biliary tract candidiasis: diagnostic and therapeutic approaches in a case series. Am J Gastroenterol. 2006;101(11):2530-2536. doi:10.1111/j.1572-0241.2006.00663.x
Lenz P, Eckelskemper F, Erichsen T, et al. Prospective observational multicenter study to define a diagnostic algorithm for biliary candidiasis. World J Gastroenterol. 2014;20(34):12260-12268. doi:10.3748/wjg.v20.i34.12260
Lenz P, Conrad B, Kucharzik T, et al. Prevalence, associations, and trends of biliary-tract candidiasis: a prospective observational study. Gastrointest Endosc. 2009;70(3):480-487. doi:10.1016/j.gie.2009.01.038
Donnelly JP, Chen SC, Kauffman CA, et al. Revision and update of the consensus definitions of invasive fungal disease from the European Organization for Research and Treatment of cancer and the mycoses study group education and research consortium. Clin Infect Dis. 2020;71(6):1367-1376. doi:10.1093/cid/ciz1008
Serraino C, Elia C, Bracco C, et al. Characteristics and management of pyogenic liver abscess: a European experience. Medicine. 2018;97(19):e0628. doi:10.1097/MD.0000000000010628
Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62(4):e1-e50. doi:10.1093/cid/civ933
Cornely OA, Bassetti M, Calandra T, et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients. Clin Microbiol Infect. 2012;18(Suppl 7):19-37. doi:10.1111/1469-0691.12039
Richaud C, De Lastours V, Panhard X, Petrover D, Fantin B, Lefort A. Candida vertebral osteomyelitis (CVO) 28 cases from a 10-year retrospective study in France. Medicine. 2017;96(31):e7525. doi:10.1097/MD.0000000000007525
Rivoisy C, Vena A, Schaeffer L, et al. Prosthetic valve Candida spp. endocarditis: new insights into long-term prognosis-the ESCAPE study. Clin Infect Dis. 2018;66(6):825-832. doi:10.1093/cid/cix913
Lefort A, Chartier L, Sendid B, et al. Diagnosis, management and outcome of Candida endocarditis. Clin Microbiol Infect. 2012;18(4):E99-E109. doi:10.1111/j.1469-0691.2012.03764.x
Danielescu C, Stanca HT, Iorga RE, Darabus DM, Potop V. The diagnosis and treatment of fungal endophthalmitis: an update. Diagnostics. 2022;12(3):679. doi:10.3390/diagnostics12030679