QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cat, T. B Articles by Rebuck, J. A Search for Related Content PubMed PubMed Citation Articles by Cat, T. B Articles by Rebuck, J. A

CRITICAL CARE

Potential Influence of Antisecretory Therapy on the Development of Candida-Associated Intraabdominal Infection

Critical Care Clinical Pharmacist, Department of Pharmacy, Antelope Valley Hospital, Lancaster, CA

William Charash, MD FACS

Associate Professor of Surgery, Fletcher Allen Health Care and the University of Vermont College of Medicine, Burlington, VT

James Hebert, MD FACS

Professor of Surgery, Fletcher Allen Health Care and the University of Vermont College of Medicine

Brian T Marden, PharmD

Medication Safety Pharmacist, Department of Pharmacy, Maine Medical Center, Portland, ME

Stephanie Mallow Corbett, PharmD

Assistant Professor, Department of Clinical Sciences & Administration, College of Pharmacy, University of Houston, Houston, TX

John Ahern, PharmD BCPS

Infectious Diseases Clinician, Department of Pharmacotherapy, Fletcher Allen Health Care

Jill A Rebuck, PharmD BCPS FCCM

Critical Care Clinical Pharmacy Specialist, Department of Pharmacy, Lancaster General Hospital, Lancaster, PA

Reprints: Dr. Rebuck, Lancaster General Hospital, Inpatient Pharmacy, 555 N. Duke St., PO Box 3555, Lancaster, PA 17604, fax 717/544-5442, jarebuck{at}lancastergeneral.org

BACKGROUND: Concerns surrounding the potential extra gut complication of gastric acid suppression are becoming increasingly realized.

OBJECTIVE: To determine whether chronic antisecretory treatment with a proton pump inhibitor (PPI) or histamine₂-receptor antagonist (H₂RA) is associated with the presence of Candida spp. in cases of complicated intraabdominal infection.

METHODS: We conducted a case-controlled study of adult surgical intensive care unit patients with complicated intraabdominal infection during a 5-year period. Exclusion criteria consisted of primary peritonitis, diagnosis of intraabdominal infection more than 72 hours before hospital admission, or a stay in the intensive care unit of less than 72 hours. Patients were categorized into either the antisecretory group (H₂RA or PPI therapy prior to admission) or control group (no prior antisecretory therapy).

RESULTS: One hundred eighteen patients met inclusion criteria. Chronic antisecretory (n = 41) and control (n = 77) patients were similar except in median age (69.0 vs 59.0 y; p = 0.026) and preadmission antibiotic use (36.6% vs 15.6%; p = 0.010). The 2 groups had a similar proportion of patients with Candida (30.3% vs 32.1%; p = 0.857); the cultures included C. albicans, C. glabrata, and C. parapsilosis. Yeast was recovered more often in patients diagnosed with community-acquired intraabdominal infection and in patients who had used PPIs before hospital admission (p = 0.066). Additionally, Candida was cultured more often in antisecretory patients with a history of prior abdominal surgery than in control patients (91.7% vs 62.5%; p = 0.066).

CONCLUSIONS: No significant difference was found in the number of patients in the antisecretory and control groups from whom peritoneal Candida was recovered. However, patients with prior abdominal surgery and those in the community with chronic PPI use may be predisposed to Candida-associated intraabdominal infections.

Key Words: antisecretory therapy, Candida, gastric acid suppression, histamine antagonist, intraabdominal infection, proton pump inhibitor, yeast

Published Online, January 22, 2008. www.theannals.com, DOI 10.1345/aph.1K328