Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: A multicenter, prospective, observational study in France (2005–2006)

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Abstract

Objective:

To describe the evolving epidemiology, management, and risk factors for death of invasive Candida infections in intensive care units (ICUs).

Design:

Prospective, observational, national, multicenter study.

Setting:

One hundred eighty ICUs in France.

Patients:

Between October 2005 and May 2006, 300 adult patients with proven invasive Candida infection who received systemic antifungal therapy were included.

Interventions:

None.

Measurements and Main Results:

One hundred seven patients (39.5%) with isolated candidemia, 87 (32.1%) with invasive candidiasis without documented candidemia, and 77 (28.4%) with invasive candidiasis and candidemia were eligible. In 37% of the cases, candidemia occurred within the first 5 days after ICU admission. C. albicans accounted for 57.0% of the isolates, followed by C. glabrata (16.7%), C. parapsilosis (7.5%), C. krusei (5.2%), and C. tropicalis (4.9%). In 17.1% of the isolates, the causative Candida was less susceptible or resistant to fluconazole. Fluconazole was the empirical treatment most commonly introduced (65.7%), followed by caspofungin (18.1%), voriconazole (5.5%), and amphotericin B (3.7%). After identification of the causative species and susceptibility testing results, treatment was modified in 86 patients (31.7%). The case fatality ratio in ICU was 45.9% and did not differ significantly according to the type of episode. Multivariate analysis showed that factors independently associated with death in ICU were type 1 diabetes mellitus (odds ratio [OR] 4.51; 95% confidence interval [CI] 1.72–11.79; p = 0.002), immunosuppression (OR 2.63; 95% CI 1.35–5.11; p = 0.0045), mechanical ventilation (OR 2.54; 95% CI 1.33–4.82; p = 0.0045), and body temperature >38.2°C (reference, 36.5–38.2°C; OR 0.36; 95% CI 0.17–0.77; p = 0.008).

Conclusions:

More than two thirds of patients with invasive candidiasis in ICU present with candidemia. Non-albicans Candida species reach almost half of the Candida isolates. Reduced susceptibility to fluconazole is observed in 17.1% of Candida isolates. Mortality of invasive candidiasis in ICU remains high.

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