Evaluation of the Innate Immune Response Through Monocyte HLA-DR Monitoring During Severe Intra-abdominal Candidiasis in the Critically Ill Patients
Intra-abdominal candidiasis (IAC) is a frequent and severe fungal infection in critically ill patients, often diagnosed late. Its pathophysiology remains unclear, particularly regarding why some patients develop invasive infection while others only show benign colonization. A potential explanation lies in the state of innate immunity. Monocyte HLA-DR expression, a recognized marker of immune suppression in critical care, may be transiently but profoundly reduced in non-immunocompromised patients who go on to develop IAC. This observational study aims to evaluate whether patients with IAC have greater innate immune dysfunction-assessed by HLA-DR expression-compared to those with severe bacterial intra-abdominal infections. The goal is to better understand the immune mechanisms involved and improve early risk stratification for IAC.
• Adult patient (≥ 18 years old)
• Patient admitted to the ICU or intermediate care unit for a severe intra-abdominal infection requiring urgent abdominal surgery
• Presence of at least one risk factor for intra-abdominal candidiasis:
‣ Abdominal surgery within the last 7 days
⁃ Supramesocolic gastrointestinal perforation
⁃ Healthcare-associated intra-abdominal infection
⁃ Community-acquired intra-abdominal infection in an immunocompromised patient\*
⁃ Intra-abdominal infection complicated by septic shock
⁃ Broad-spectrum antibiotic exposure within 72 hours prior to surgery
• And/or a Peritonitis Score ≥ 3 out of 4
• Patient affiliated with or benefiting from a national health insurance system
• Patient who has received full information about the clinical study