Candida albicans versus non-albicans intensive care unit-acquired bloodstream infections: differences in risk factors and outcome

G Dimopoulos, F Ntziora, G Rachiotis… - Anesthesia & …, 2008 - journals.lww.com
Anesthesia & Analgesia, 2008journals.lww.com
OBJECTIVE: In this study we sought to identify differences in risk factors and outcome of
critically ill patients with Candida albicans and non-albicans candidemia. METHODS:
Nonimmunosuppressed, nonneutropenic patients with candidemia diagnosed after
intensive care unit (ICU) admission were included in a prospective observational study in a
medical-surgical ICU at a tertiary academic hospital in Athens, Greece. RESULTS: During
the study period (January 2001 to December 2005), 56 candidemia episodes in 1037 ICU …
OBJECTIVE:
In this study we sought to identify differences in risk factors and outcome of critically ill patients with Candida albicans and non-albicans candidemia.
METHODS:
Nonimmunosuppressed, nonneutropenic patients with candidemia diagnosed after intensive care unit (ICU) admission were included in a prospective observational study in a medical-surgical ICU at a tertiary academic hospital in Athens, Greece.
RESULTS:
During the study period (January 2001 to December 2005), 56 candidemia episodes in 1037 ICU admissions were included (5.4%). Of these patients, 36/56 (64.3%) had candidemia due to C. albicans and 20/56 (35.7%) due to non-albicans species (8/56 [14.3%] C. glabrata, 6/56 [10.7%] C. tropicalis, 3/56 [5.4%] C. parapsilosis, 1/56 [1.8%] C. lusitaniae, 1/56 [1.8%] C. krusei and 1/56 [1.8%] C. dubliniensis). Administration of glucocorticosteroids, central venous catheter placement, and preexisting candiduria were independently associated with candidemia due to C. non-albicans species (Odds ratio [OR]: 45.1, 95% confidence interval [CI]: 3.0–669.9; OR: 26.2, 95% CI: 2.1–334.8; and OR: 16.5, 95% CI: 1.6–173.9, respectively). The treatment response rate differed significantly between patients with C. albicans and patients with C. non-albicans bloodstream infections (29/36 [80.6%] vs 9/20 [45%], P= 0.006). Overall mortality was higher in patients with non-albicans species than C. albicans bloodstream infections (18/20 [90%] vs 19/36 [52.8%], P= 0.005). Multivariable logistic regression analysis revealed that candidemia due to non-albicans species was independently associated with death (OR: 6.7, 95% CI: 1.2–37.7).
CONCLUSIONS:
In the subset of critically ill nonimmunosuppressed patients, candidemia caused by non-albicans species occurred more frequently in those with medical devices or receiving steroids. Candidemia due to non-albicans species was also associated with higher mortality.
IMPLICATIONS: In critically ill nonimmunosuppressed patients, candidemia caused by non-albicans species, which is associated with higher mortality, was more likely to occur in patients with medical devices or receiving steroids.
Lippincott Williams & Wilkins
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