Epidemiology of invasive fungal infections in the intensive care unit: results of a multicenter Italian survey (AURORA Project)

Abstract

PurposeThe aims of this study are to evaluate the epidemiology of invasive fungal infections (IFIs) in patients admitted to an intensive care unit (ICU) in Southern Italy and the in vitro antifungal susceptibility of isolates.MethodsA surveillance program was implemented in 18 ICUs. IFI cases were recorded using a standardized form.ResultsA total of 105 episodes of IFIs occurred in 5,561 patients during the 18-month study. The main infections were caused by yeasts, more than filamentous fungi (overall incidence of 16.5 cases per 1,000 admissions and 2.3 cases per 1,000 admissions, respectively). The overall crude mortality rate was high (42.8 %), particularly for mold infections (61.5 %). All yeast infections were Candida bloodstream infections. Over half (59.8 %) were caused by Candida non-albicans, with C. parapsilosis being the most common (61.8 %). In the multivariate model, trauma admission diagnosis, prolonged stay in the ICU, and parenteral nutrition were independently associated with candidemia due to C. parapsilosis [odds ratio (OR) 3.5, (1.8–5.2); OR 3.5, (1.02–3.5); OR 3.6, (1.28–6.99), respectively]. Among mold infections, 12 patients suffered from invasive pulmonary aspergillosis, with Aspergillus fumigatus as the predominant pathogen (41.7 %). One case of brain scedosporiosis was identified. Overall, azoles and echinocandins resistance was uncommon.ConclusionsCandida non-albicans species are the most frequent cause of candidemia in ICU patients. Mold infections are associated with a high mortality rate. This study confirms the importance of the epidemiological surveillance on IFIs in the ICU setting for documenting species distribution and antimicrobial susceptibility patterns to guide therapeutic choices.

Molecular identification and antifungal susceptibility profiles of Candida parapsilosis complex species isolated from culture collection of clinical samples

“…Within the genus Candida, C. parapsilosis is the second most commonly isolated species from blood cultures in several casuistics (5) (14) (15) . Moreover, this species represents frequent cause of onychomycosis in several countries, including Brazil (4) , Chile (16) , México (17) , and Iran (18) .…”

Fungal endocarditis in an extremely low birth weight infant. Case report

“…2,7,8 Fungal infections incidence was 0.5% in our NICU and we previously had no mortality due to fungal sepsis. The most common Candida types are C. albicans and C. parapsilosis.…”

“…Tests such as anti-Candida antibody, beta-glucan antibody, d-arabinitol concentration, polymerase chain reaction (PCR) exist to determine Candida infection but not widely used. [1][2][3][4]8 The possibility of detecting in blood culture is 28-50% and we were able to detect it in our infant. 4,5,7 Central nervous system (CNS), urinary system, eye, heart, liver involvements may be seen due to hematogenous spread.…”

Antifungal susceptibility, risk factors and treatment outcomes of patients with candidemia at a university hospital in Saudi Arabia

“…(CBSI) is often a consequence of long term use of broad-spectrum antibacterial therapy, complex surgical procedures and invasive medical devices. The epidemiology of candidemia is changing with an increase in the proportion of NAC [16]. (2) During the current study; overall mortality associated with candidemia was 60.3 % (Table 1).…”