Candidemia in critically ill immunocompromised patients: report of a retrospective multicenter cohort study

Abstract

Background Immunocompromised critically ill patients constitute a population with the high risk of candidemia. This retrospective study aimed to assess the outcome of immunocompromised critically ill patients with candidemia. Secondary objectives were to describe clinical phenotypes of these patients, Candida ecology, and factors associated with mortality. Results Overall, 121 patients were included in this study. Median delay from candidemia to first antifungal therapy was 3 days, in line with the observed delay of blood culture positivity. Candia albicans was the main Candida specie identified (54%), and susceptibility of Candida to fluconazole and echinocandins was of, respectively, 70% and 92%. Hospital mortality was of 60%. After adjustment for confounders, severity as assessed by the need for vasopressors (HR 1.8, CI95% 1.1–3.1), need for mechanical ventilation (HR 2.0, CI95% 1.1–3.8) and allogenic stem cell transplantation (HR 2.5, CI95% 1.1–6.0) were independently associated with poor outcome. Candida specie, susceptibility and treatment strategies were not associated with outcome. Conclusions Candidemia in immunocompromised critically ill patients is associated with a grim outcome. Despite the high prevalence of Candida non- albicans species, neither C. species nor its susceptibility was associated with outcome. Conversely, severity and preexisting allogeneic stem cell transplantation were independently associated with poor outcome. Despite antifungal prophylaxis and use of preemptive antifungal therapy in neutropenic patients, antifungal therapy was initiated three days after symptoms onset suggesting needs for specific strategies aiming to reduce this delay. Electronic supplementary material The online version of this article (10.1186/s13613-019-0539-2) contains supplementary material, which is available to authorized users.

Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis

“…to specific antifungal drugs may not necessarily correlate with outcome. Ghrenassia and colleagues observed that Candida susceptibility was not associated with survival after candidemia in immunocompromised patients [21]. Neither was the choice of antifungal agent in favor of echinocandins.…”

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“…C. albicans is an opportunistic pathogen of global clinical significance [ 48 , 49 , 50 ]. Preventing biofilm formation and eradicating existing biofilms is important to reduce mortality rates of infections caused by these microorganisms.…”

Multicenter Evaluation of a PCR-Based Digital Microfluidics and Electrochemical Detection System for the Rapid Identification of 15 Fungal Pathogens Directly from Positive Blood Cultures

“…Previously, a multi-center study has shown that the mortality rate significantly increased for every hour delayed in diagnosis of candidemia (2). Rapid diagnosis of candidemia is even more crucial in immunocompromised patient populations because of a higher mortality rate in this patient group (3,4). Conventional culture-based identification methods lack the speed needed to aid in choosing the appropriate antifungal drugs for timely management of patients suffering from these invasive fungal infections.…”