Can yeast isolation in peritoneal fluid be predicted in intensive care unit patients with peritonitis?

Crit Care Med. 2003 Mar;31(3):752-7. doi: 10.1097/01.CCM.0000053525.49267.77.


Objective: To generate and validate a predictive score of yeast isolation based on independent risk factors of yeast isolation in intensive care unit patients with peritonitis.

Design: Retrospective cohort study to determine independent risk factors of yeast isolation, generation of the score, and validation in a prospective cohort of patients with peritonitis.

Setting: Tertiary-care, university-affiliated hospital.

Patients: Two hundred twenty-one patients with peritonitis hospitalized in a surgical intensive care unit between 1994 and 1999 for the retrospective cohort and 57 patients in the prospective cohort (2000).

Measurements and main results: Four independent risk factors of yeast isolation in peritoneal fluid (similar odds ratio) were found in the retrospective cohort: female gender, upper gastrointestinal tract origin of peritonitis, intraoperative cardiovascular failure, and previous antimicrobial therapy at least 48 hrs before the onset of peritonitis. A score based on the number of risk factors was constructed (grade A = zero or one risk factor, grade B = at least two risk factors, grade C = at least three risk factors, and grade D = four risk factors), and validated in the prospective cohort. For a grade C score, sensitivity was 84%, specificity was 50%, positive and negative predictive values were 67% and 72%, respectively, and overall accuracy was 71%.

Conclusions: Four independent risk factors of yeast isolation in the peritoneal fluid were identified in critically ill surgical patients with peritonitis. The presence of at least three of these factors (grade C score) was associated with a high rate of yeast detection. This approach could be helpful to initiate early antifungal therapy in this patient population.

MeSH terms

  • Aged
  • Anti-Bacterial Agents / adverse effects
  • Ascitic Fluid / microbiology*
  • Bacterial Infections / complications
  • Bacterial Infections / microbiology
  • Candida / isolation & purification*
  • Candidiasis / complications
  • Candidiasis / microbiology*
  • Candidiasis / mortality
  • Cross Infection / complications
  • Cross Infection / microbiology*
  • Cross Infection / mortality
  • Female
  • Hospital Mortality
  • Humans
  • Infection Control / methods
  • Intensive Care Units
  • Logistic Models
  • Male
  • Middle Aged
  • Multiple Organ Failure / microbiology
  • Peritonitis / complications
  • Peritonitis / microbiology*
  • Peritonitis / mortality
  • Predictive Value of Tests
  • Prospective Studies
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index*
  • Survival Analysis
  • Time Factors


  • Anti-Bacterial Agents