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Original article
Intra-abdominal Candida spp infection in acute abdomen in a quality assurance (QA)-certified academic setting
  1. Vito Rodolico1,
  2. Paola Di Carlo2,
  3. Gaspare Gulotta3,
  4. Francesco D'Arpa3,
  5. Giuseppe Salamone3,
  6. Gianfranco Cocorullo3,
  7. Antonino Agrusa3,
  8. Anna Giammanco4,
  9. Consolato Sergi5,6
  1. 1Department of Sciences for Health Promotion and Mother & Child Care, Section of Anatomic Pathology, University of Palermo, Palermo, Italy
  2. 2Department of Sciences for Health Promotion and Mother & Child Care, Section of Infectious Disease, University of Palermo, Palermo, Italy
  3. 3Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
  4. 4Department of Sciences for Health Promotion and Mother & Child Care, Section of Microbiology, University of Palermo, Palermo, Italy
  5. 5Department of Lab. Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
  6. 6Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
  1. Correspondence to Professor Consolato Sergi, Department of Lab Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada T6G 2B7; sergi{at}ualberta.ca

Abstract

Aims To evaluate the contribution of light microscopy to detecting Candida spp infection in patients with complicated intra-abdominal infections (IAIs) admitted for acute abdomen to a quality assurance (QA)-certified surgical emergency ward.

Methods We conducted a retrospective study (2008–2012) of 809 abdominal intraoperative or biopsy tissue specimens obtained from patients admitted with acute abdomen and microbiological samples positive for Candida spp. Demographic data, mortality, comorbidities, specimen type, microscopy results, special histological staining performed, antimicrobial therapy were collected and analysed. Any comments at the multidisciplinary team meeting was recorded in minutes of and approved.

Results Sixty-six patients with complicated IAIs due to Candida spp were identified (39 male, 27 female, mean±SD age 75±20 years). Candida albicans was isolated in 35 cases and Candida non-albicans spp in 31 cases. Candida spp were isolated from blood in 50% of all selected microbiological specimens. Patients were stratified according to Candida spp (albicans vs non-albicans), underlying cancer disease and no previous antimicrobial administration, and a positive correlation with C. albicans isolation was found (p=0.009 and p=0.048, respectively). Out of 41 cases with microscopic evaluation, we identified yeast forms, pseudohyphae or both, indicative of Candida spp, in 23. Identification of Candida spp in histological specimens was higher in C. albicans cases than in C. non-albicans cases (73% vs 37.5%). Microscopy allowed prompt treatment of all patients.

Conclusions Light microscopy still has great diagnostic significance, being a solid QA step. It provides rapid information and clues in patients who may harbour impaired defence mechanisms, concurrent chronic conditions and/or cancer.

  • GASTROENTEROLOGY
  • INFECTIONS
  • INFECTIOUS INTESTINAL DISEASE
  • FUNGI

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/jclinpath-2016-203936

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    Footnotes

    • Handling editor Slade Jensen

    • Twitter Follow Paola Di Carlo at @paoladicarlo19@gmail.com

    • Contributors VR and PDC wrote the first draft of the manuscript. GG, FDA, GS, GC and AA identified patients and settings and provided care and follow-up. VR reviewed the original histological slides. AG provided the microbiological diagnosis. CS reviewed the first draft of the manuscript, critically appraised the study and data, and wrote the final version of the manuscript.

    • Competing interests None declared.

    • Ethics approval University of Palermo.

    • Provenance and peer review Not commissioned; externally peer reviewed.