Outcome and potentially modifiable risk factors for candidemia in critically ill burns patients: A matched cohort study

Abstract

Summary Background Patients with extensive burns are at risk of developing candidemia. Objectives To identify potentially modifiable risk factors and outcomes of candidemia in critically ill burns patients. Patients and Methods Retrospective matched cohort study including adult burns patients. Patients who developed candidemia were matched with burns patients with Candida spp colonisation and sepsis or septic shock without candidemia in a ratio of 1:3 (same severity scores and colonisation index). Univariate and multiple regression analyses were performed. Results Of 130 severely burned patients with Candida spp colonisation and at least one episode of sepsis or septic shock, 14 were diagnosed with candidemia. In the candidemia group, patients had a median (IQR) total burns surface area (TBSA) of 57 (38‐68)%, SAPSII of 43 (36‐58) and ABSI of 11 (8‐13). Multiple regression analysis showed that only duration of prior antibiotic therapy was independently associated with candidemia. ICU mortality was higher in the candidemia group (71% vs 35% [P = 0.02]). The log‐rank test for 28‐day mortality comparing patients with candidemia treated with an empirical strategy vs a curative strategy did not reach significance (P = 0.056). Conclusions Burns patients having received recent antibiotherapy have a higher risk of candidemia. Antifungal strategies did not influence outcome in this series.

Characteristics and outcomes of culture-negative versus culture-positive with fungus in sepsis patients: a retrospective analysis of the MIMIC-III database

“…(23) Antifungal therapy also did not signi cantly improve prognosis in burn patients. (9) Therefore, in the early stage of sepsis, antifungal agents had no signi cant effect on death regardless of the patients' fungal culture status.…”

Quantification of 1,3‐β‐d‐glucan by Wako β‐glucan assay for rapid exclusion of invasive fungal infections in critical patients: A diagnostic test accuracy study

“…This was a non‐interventional, retrospective, diagnostic test accuracy study, conducted at the ASST Grande Ospedale Metropolitano Niguarda, (Milan, Italy). Patients aged > 18 years admitted for clinical conditions associated with an increased risk of IFIs, 12,13,27‐39 and who had been tested for serum BDG levels between 1 February and 31 October 2018 while exhibiting clinical signs and/or symptoms indicative of a suspected IFI, were retrospectively evaluated for inclusion. Decisions on patients’ inclusion and disease classification (see next paragraph) were performed by a multidisciplinary team of microbiologists, haematologists, anaesthesiologists and infectious disease specialists, who were blind to the result of BDG testing.…”

“…Eligible patients from ICUs were included if exhibited a Candida score > 2.5 (in the case of complicated intra‐abdominal infections), 40 and/or sepsis or septic shock, 41 in addition to at least one risk factor, as defined by 12,13,28 . Clinical signs and/or symptoms of IFI also elected for inclusion patients admitted to other clinical or surgical wards with fever (body temperature > 38°C), and/or sepsis, 41 in addition to at least two risk factors, as defined by 12,29‐39 …”

Time to and differential time to blood culture positivity for assessing catheter‐related yeast fungaemia: A longitudinal, 7‐year study in a single university hospital

“…Burn patients were excluded as these were analysed separately because all the removed catheter tips were culture‐negative for Candida spp. suggesting that CVC is not the source of candidaemia whereas candidaemia was always concomitant with Candida carriage of the skin …”