Determinants of Candidemia and Candidemia-Related Death in Cardiothoracic ICU Patients

Michalopoulos, Argyris; Geroulanos, Stefanos; Mentzelopoulos, Spyros D.

doi:10.1378/chest.124.6.2244

Cited by 107 publications

(88 citation statements)

References 107 publications

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“…Confirming earlier reports (Bassetti et al 2007;Blumberg et al 2001;Bross et al 1989;Sung et al 2001;Wey et al 1989), our study showed that renal insufficiency was independently related to candidaemia in the logistic regression model. Our study did not find other significant host-related factors, which is in contrast to other studies that reported diabetes mellitus (Michalopoulos et al 2003;Wu et al 2014), HIV infection (Chowta et al 2007;Petrosillo et al 2002), malignancy (Zaoutis et al 2010) and prematurity (Saiman et al 2000;Wu et al 2013), as significant risk factors. This could possibly due to several factors -our small sample size, particularly for HIV infection and prematurity; different study population by Zaoutis et al (2010) who included only paediatric patients and diabetes mellitus being too prevalent in our population that it is present too often in both groups.…”

Section: Discussioncontrasting

confidence: 99%

Risk Factors for Candidaemia in a Malaysian Tertiary Hospital

Khaithir¹,

Norazlah

Shah³

2015

JSM

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Section: Discussioncontrasting

confidence: 99%

Risk Factors for Candidaemia in a Malaysian Tertiary Hospital

Khaithir¹,

Norazlah

Shah³

2015

JSM

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“…(such as indwelling catheters, renal failure, total parenteral nutrition, etc.) are difficult to modify 5,[30][31][32][33][34] especially among NTES patients that require urgent interventions. Surprisingly, even patients colonized with Candida had prolonged ICU stays and higher total hospital costs.…”

Section: Discussionmentioning

confidence: 99%

Candidainfection and colonization among non-trauma emergency surgery patients

Kourkoumpetis

Manolakaki²,

Velmahos³

et al. 2010

Virulence

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IntroductionCandida is a fungus, which accounts for nearly 96% of all opportunistic mycoses and is the fourth most common bloodstream pathogen in North American and seventh in European hospitals. 1,2 Among critically ill patients, candidiasis is associated with overall severity of illness, increased rate of invasive interventions, use of broadspectrum antibiotics and parenteral nutrition, which are all unavoidable among critically ill patients.3-5 Candidiasis prolongs both intensive care unit (ICU) and hospital stays and candidemia can increase hospital cost by $40,000 per survivor.6,7 Nonetheless, in a nationwide study the crude mortality of candidemia in the ICU was 47%. Even though candidiasis has been well studied in other critically ill patient groups such as trauma patients as well as in certain high-risk groups, such as patients with neutropenia, bone marrow transplant recipients or HIV-infected individuals, literature examining specific risk factors for candidiasis among non-trauma emergency surgery patients is lacking. This patient Background: candida is a significant pathogen among critically ill patients. however, candidiasis among non-trauma emergency surgery (NTeS) patients has not been previously investigated. herein we describe the incidence of both colonization and infection from candida and risk factors for invasive disease in this population. Results: Of all 289 eligible patients, 63 (21.7%) fulfilled the criteria for candida infection and 110 (38%) were included in the candida colonization group. Interestingly, from the 63 patients with invasive candidiasis, 25 (39.7%) were infected by a non-albicans species. Upon multivariate analyses, ventilator-associated pneumonia (Vap) (Odds Ratio [OR]: 2.34; 95%, confidence Interval [cI]: 1,213-4,533, p = 0.0112), bacteremia (OR: 4,778; 95% cI: 1,519-15,029, p = 0.0075) and surgical complications (OR: 3.903; 95% cI: 1,335-11,412, p = 0.0129) were independent risk factors for the development of candida infection. candida infection and colonization were both found to correlate with approximately $40,000-100,000 mean additional costs). Interestingly, candidemia was associated with 63% all-cause mortality. For all other forms of candidiasis, mortality was not significantly different among groups. Methods: For this retrospective single center study we included all NTeS patients with IcU stay ≥4 days from May 1 st , 2002 to april 30 th , 2007. patients were divided into 3 non-overlapping groups: (1) patients with candida-infection, (2) patients with candida colonization and (3) patients with negative candida cultures. Groups were compared by univariate and multivariate analyses to identify significant risk factors for invasive candidiasis. Conclusion: We found that candida infection is alarmingly high among NTeS patients with prolonged intensive care unit (IcU) stay. Surgical complications and bacterial infections (Vap and bacteraemia) were significantly correlated with the development of candidiasis. candidiasis reached a rate of 21.7/100 discharges, which is...

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“…This was usually due to gram-negative bacterial infection and was often associated with complications of abdominal surgery. Recent or concomitant bacteremia, abdominal surgery, deep organ involvement, and multiple-organ failure all correlate with a poor prognosis in patients with candidiasis [22,[28][29][30].…”

Section: Discussionmentioning

confidence: 99%

A Randomized, Blinded, Multicenter Trial of Lipid-Associated Amphotericin B Alone versus in Combination with an Antibody-Based Inhibitor of Heat Shock Protein 90 in Patients with Invasive Candidiasis

Pachl

Svoboda

Jacobs

et al. 2006

Clinical Infectious Diseases

266

148

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Background. Mycograb (NeuTec Pharma) is a human recombinant monoclonal antibody against heat shock protein 90 that, in laboratory studies, was revealed to have synergy with amphotericin B against a broad spectrum of Candida species.Methods. A double-blind, randomized study was conducted to determine whether lipid-associated amphotericin B plus Mycograb was superior to amphotericin B plus placebo in patients with culture-confirmed invasive candidiasis. Patients received a lipid-associated formulation of amphotericin B plus a 5-day course of Mycograb or placebo, having been stratified on the basis of Candida species (Candida albicans vs. non-albicans species of Candida). Inclusion criteria included clinical evidence of active infection at trial entry plus growth of Candida species on culture of a specimen from a clinically significant site within 3 days after initiation of study treatment. The primary efficacy variable was overall response to treatment (clinical and mycological resolution) by day 10.Results. Of the 139 patients enrolled from Europe and the United States, 117 were included in the modified intention-to-treat population. A complete overall response by day 10 was obtained for 29 (48%) Conclusions. Mycograb plus lipid-associated amphotericin B produced significant clinical and culture-confirmed improvement in outcome for patients with invasive candidiasis.

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Determinants of Candidemia and Candidemia-Related Death in Cardiothoracic ICU Patients

Cited by 107 publications

References 107 publications

Risk Factors for Candidaemia in a Malaysian Tertiary Hospital

Risk Factors for Candidaemia in a Malaysian Tertiary Hospital

Candidainfection and colonization among non-trauma emergency surgery patients

A Randomized, Blinded, Multicenter Trial of Lipid-Associated Amphotericin B Alone versus in Combination with an Antibody-Based Inhibitor of Heat Shock Protein 90 in Patients with Invasive Candidiasis

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