Acute cholecystitis in recent lung transplant patients: a single-institution series of 10 cases.

OBJECTIVE: To evaluate the clinical and imaging findings of acute cholecystitis in recent lung transplant patients. METHODS: We retrospectively reviewed all abdominal ultrasounds and computed tomography (CT) scans of patients who developed acute cholecystitis in the early postoperative period following lung transplantation from November 2014 to December 2020 in a tertiary care university hospital. RESULTS: Ten patients (4.4%) were included in this series (6 male, mean age 62.9 years ± 2.1 [standard deviation]) of a total 227 lung transplant patients performed from November 2014 to December 2020 (172 unilateral and 55 bilateral). Nine (90%) patients received a double-lung transplant and seven (70%) required extracorporeal circulation during surgery. Acute cholecystitis occurred during the initial admission for lung transplantation (average of 33 ± 25.9 days post-transplantation). Six patients (60%) died during admission with an average of 24.3 ± 21.8 days after cholecystectomy. The most frequent imaging findings were gallbladder wall discontinuity or decreased gallbladder mural enhancement (100%, 10 patients) and gallbladder distension (90%, 9 patients). All acute cholecystitis were found to be ischemic / gangrenous at surgery and/or pathology, 40% (4 patients) were hemorrhagic and 30% (3 patients) were perforated, one of them with a cholecystoduodenal fistula. Fungal cholecystitis was demonstrated at histological exam in one patient. CONCLUSION: Acute cholecystitis in the early postoperative period after lung transplantation is an important cause of morbidity and mortality. Ischemic or gangrenous cholecystitis prevails. The key imaging findings are parietal perfusion defects and gallbladder distension, which can easily go unnoticed if not specifically looked for.

Intraabdominal candidiasis in surgical ICU patients treated with anidulafungin: A multicenter retrospective study / Candidiasis intraabdominal en pacientes críticos quirúrgicos tratados con anidulafungina: estudio retrospectivo multicéntrico

Introduction. Patients with recent intraabdominal events are at uniquely risk for intraabdominal candidiasis (IAC). Candida peritonitis is a frequent and life-threatening complication in surgically ill patients. International guidelines do not specifically address IAC. This study describes clinical features of IAC in critical patients treated with anidulafungin in Surgical ICUs (SICUs). Material and methods. A practice-based retrospective study was performed including all adults with IAC admitted to 19 SICUs for ≥24h treated with anidulafungin. IAC was documented (Candida isolation from blood/peritoneal fluid/abscess fluid and/or histopathological confirmation) or presumptive (host factors plus clinical criteria without mycological support). Total population and the subgroup of septic shock patients were analyzed. Results. One hundred and thirty nine patients were included, 94 (67.6%) with septic shock, 112 (86.2%) after urgent surgery. Of them, 77.7% presented peritonitis and 21.6% only intraabdominal abscesses. Among 56.8% cases with documented IAC, C. albicans (52.8%) followed by C. glabrata (27.8%) were the most frequent species. Anidulafungin was primarily used as empirical therapy (59.7%), microbiologically directed (20.9%) and anticipated therapy (15.8%). Favourable response was 79.1% (76.6% among patients with septic shock). Intra-SICU mortality was 25.9% (28.7% among patients with septic shock). Conclusions. Among IACs managed at SICUs, peritonitis was the main presentation, with high percentage of patients presenting septic shock. C. albicans followed by C. glabrata were the main responsible species. Anidulafungin treatment was mostly empirical followed by microbiologically directed therapy, with a favourable safety profile, even among patients with septic shock (AU)

Introducción. Los pacientes con cirugía intraabdominal reciente presentan alto riesgo de candidiasis intraabdominal (CIA). La peritonitis por Candida es una complicación frecuente y comporta riesgo vital en los pacientes críticos quirúrgicos. Las recomendaciones internacionales no abordan específicamente la CIA. Este estudio describe las características de la CIA en pacientes críticos tratados con anidulafungina ingresados en Unidades de Cuidados Críticos Quirúrgicos (UCCQs). Material y métodos. Se llevó a cabo un estudio retrospectivo incluyendo a todos los pacientes con CIA ingresados en 19 UCCQs durante al menos 24h y tratados con anidulafungina. La CIA se consideró documentada cuando se aisló Candida de sangre/líquido peritoneal/absceso y/o hubo confirmación histopatológica, y presumible cuando estaban presentes factores del huésped y criterios clínicos sin aislamiento microbiológico. Se analizó el grupo total de pacientes, así como el subgrupo de pacientes que presentaban shock séptico por separado. Resultados. Se incluyeron 139 pacientes, 94 (67,6%) con shock séptico, 112 (86,2%) tras cirugía urgente. De ellos, 77,7% presentaban peritonitis y 21,6% absceso intraabdominal exclusivamente. Entre los 56,8% casos con CIA documentada, C. albicans (52,8%) seguido de C. glabrata (27,8%) fueron las especies más frecuentes. Anidulafungina se utilizó principalmente como tratamiento empírico (59,7%), dirigido (20,9%) o anticipado (15,8%). La respuesta fue favorable en el 79,1% de los pacientes (76,6% en pacientes con shock séptico). La mortalidad intra-UCCQ fue del 25,9% (28,7% en pacientes con shock séptico). Conclusiones. Entre las CIAs tratadas en UCCQs, la peritonitis es la presentación clínica más frecuente, con un alto porcentaje de pacientes con shock séptico. C. albicans seguido de C. glabrata fueron las principales especies responsables de la infección. Anidulafungina se utilizó en la mayoría de casos como tratamiento empírico seguido de como tratamiento dirigido, con un perfil de seguridad favorable, incluso entre los pacientes que presentaban shock séptico (AU)

Intraabdominal candidiasis in surgical ICU patients treated with anidulafungin: A multicenter retrospective study.

OBJECTIVE: Patients with recent intraabdominal events are at uniquely risk for intraabdominal candidiasis (IAC). Candida peritonitis is a frequent and life-threatening complication in surgically ill patients. International guidelines do not specifically address IAC. This study describes clinical features of IAC in critical patients treated with anidulafungin in Surgical ICUs (SICUs). METHODS: A practice-based retrospective study was performed including all adults with IAC admitted to 19 SICUs for ≥24h treated with anidulafungin. IAC was documented (Candida isolation from blood/peritoneal fluid/abscess fluid and/or histopathological confirmation) or presumptive (host factors plus clinical criteria without mycological support). Total population and the subgroup of septic shock patients were analyzed. RESULTS: One hundred and thirty nine patients were included, 94 (67.6%) with septic shock, 112 (86.2%) after urgent surgery. Of them, 77.7% presented peritonitis and 21.6% only intraabdominal abscesses. Among 56.8% cases with documented IAC, C. albicans (52.8%) followed by C. glabrata (27.8%) were the most frequent species. Anidulafungin was primarily used as empirical therapy (59.7%), microbiologically directed (20.9%) and anticipated therapy (15.8%). Favourable response was 79.1% (76.6% among patients with septic shock). Intra-SICU mortality was 25.9% (28.7% among patients with septic shock). CONCLUSIONS: Among IACs managed at SICUs, peritonitis was the main presentation, with high percentage of patients presenting septic shock. C. albicans followed by C. glabrata were the main responsible species. Anidulafungin treatment was mostly empirical followed by microbiologically directed therapy, with a favourable safety profile, even among patients with septic shock.