Characteristics and risk factors for 28-day mortality of hospital acquired fungemias in ICUs: data from the EUROBACT study

Abstract

BackgroundTo characterize and identify prognostic factors for 28-day mortality among patients with hospital-acquired fungemia (HAF) in the Intensive Care Unit (ICU).MethodsA sub-analysis of a prospective, multicenter non-representative cohort study conducted in 162 ICUs in 24 countries.ResultsOf the 1156 patients with hospital-acquired bloodstream infections (HA-BSI) included in the EUROBACT study, 96 patients had a HAF. Median time to its diagnosis was 20 days (IQR 10.5–30.5) and 9 days (IQR 3–15.5) after hospital and ICU admission, respectively. Median time to positivity of blood culture was longer in fungemia than in bacteremia (48.7 h vs. 38.1 h; p = 0.0004). Candida albicans was the most frequent fungus isolated (57.1 %), followed by Candida glabrata (15.3 %) and Candida parapsilosis (10.2 %). No clear source of HAF was detected in 33.3 % of the episodes and it was catheter-related in 21.9 % of them. Compared to patients with bacteremia, HAF patients had a higher rate of septic shock (39.6 % vs. 21.6 %; p = 0.0003) and renal dysfunction (25 % vs. 12.4 %; p = 0.0023) on admission and a higher rate of renal failure (26 % vs. 16.2 %; p = 0.0273) at diagnosis. Adequate treatment started within 24 h after blood culture collection was less frequent in HAF patients (22.9 % vs. 55.3 %; p < 0.001). The 28-day all cause fatality was 40.6 %. According to multivariate analysis, only liver failure (OR 14.35; 95 % CI 1.17–175.6; p = 0.037), need for mechanical ventilation (OR 8.86; 95 % CI 1.2–65.24; p = 0.032) and ICU admission for medical reason (OR 3.87; 95 % CI 1.25–11.99; p = 0.020) were independent predictors of 28-day mortality in HAF patients.ConclusionsFungi are an important cause of hospital-acquired BSI in the ICU. Patients with HAF present more frequently with septic shock and renal dysfunction on ICU admission and have a higher rate of renal failure at diagnosis. HAF are associated with a significant 28-day mortality rate (40 %), but delayed adequate antifungal therapy was not an independent risk factor for death. Liver failure, need for mechanical ventilation and ICU admission for medical reason were the only independent predictors of 28-day mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1229-1) contains supplementary material, which is available to authorized users.

Incidence and outcome of invasive candidiasis in intensive care units (ICUs) in Europe: results of the EUCANDICU project

“…In the last 10 years, other series addressed specifically the cumulative incidence of IC in the ICU setting [6–10]. The majority of those studies was limited to candidemia, some were limited to one or a few countries, and some occasionally included cases not representing true infections but colonization [6–10].…”

“…The majority of those studies was limited to candidemia, some were limited to one or a few countries, and some occasionally included cases not representing true infections but colonization [6–10]. …”

Etest and Sensititre YeastOne Susceptibility Testing of Echinocandins against Candida Species from a Single Center in Austria

“…andida species are leading pathogens causing health care-associated bloodstream infections with septic shock and high mortality (1,2). Anidulafungin, caspofungin, and micafungin are recommended as first-line drugs for the treatment of invasive candidiasis (3,4).…”

Biomarker-guided antifungal therapy in patients with suspected invasive candidiasis: Ready for prime time?

“…are responsible for around 20% of all microbiologically documented infections in the intensive care unit (ICU), and the incidence of invasive fungal infections (IFI) has increased steadily [1]. As reported recently, 28-day crude mortality rates remain high in those patients, around 40% [2]. Delayed antifungal therapy (AFT) is associated with significant increase in hospital mortality and health care costs and is mainly linked to late diagnosis [3,4].…”

“…Delayed antifungal therapy (AFT) is associated with significant increase in hospital mortality and health care costs and is mainly linked to late diagnosis [3,4]. Accordingly, blood cultures are positive in only 50-70% of cases of candidemia and time to positivity is longer than in bacteremia [2]. As a result, empirical AFT is broadly used in the ICU.…”