Association between hollow viscous injury and invasive candidiasis in critically ill trauma patients.

Mehreen Kisat; Manuel Castillo-Angeles ; Adil Haider; Ali Salim; Reza Askari MD

Invasive candidiasis is associated with high mortality in critically ill patients. The use of empiric antifungal therapy is controversial in patients with traumatic injury to the gastrointestinal tract (GI).

We hypothesized that injury to the proximal bowel (stomach, duodenum) is associated with a greater risk of invasive candidiasis than more distal bowel injury.

Adult ICU patients (≥ 16 years) in the National Trauma Data Bank (2010-2015) were categorized by site of injury to the gastrointestinal tract (stomach, duodenum, jejunum, colon/rectum). The primary outcome was a diagnosis of invasive candidiasis. Multivariable logistic regression was used to determine associations between the site of injury and invasive candidiasis while controlling for patient (age, gender), injury (injury severity score, injury type) and clinical characteristics (hypotension, ventilator dependency, need for blood transfusion, total parental nutrition, and dialysis).

Among the 835,024 patients included, 0.02% (n=142) had invasive candidiasis, with an associated mortality rate of approximately 11%. Patients with gastric injury were more likely to have invasive candidiasis (Table 1). Other factors independently associated with invasive candidiasis were hypotension, ventilator dependency, need for transfusion and dialysis.

Table 1: Adjusted odds ratios for predictors of Candidiasis using site of GI injury as a covariate (n=819,156).

Invasive candidiasis is associated with significant mortality in trauma patients with hollow viscous injury. Gastric injuries are associated with increased risk of invasive candidiasis. These results highlight strong consideration for empiric antifungal therapy in trauma patients with gastric injuries and the other known risk factors.