Risk factors for candidaemia: A prospective multi‐centre case‐control study

Abstract

Objectives Candidaemia carries a mortality of up to 40% and may be related to increasing complexity of medical care. Here, we determined risk factors for the development of candidaemia. Methods We conducted a prospective, multi‐centre, case‐control study over 12 months. Cases were aged ≥18 years with at least one blood culture positive for Candida spp. Each case was matched with two controls, by age within 10 years, admission within 6 months, admitting unit, and admission duration at least as long as the time between admission and onset of candidaemia. Results A total of 118 incident cases and 236 matched controls were compared. By multivariate analysis, risk factors for candidaemia included neutropenia, solid organ transplant, significant liver, respiratory or cardiovascular disease, recent gastrointestinal, biliary or urological surgery, central venous access device, intravenous drug use, urinary catheter and carbapenem receipt. Conclusions Risk factors for candidaemia derive from the infection source, carbapenem use, host immune function and organ‐based co‐morbidities. Preventive strategies should target iatrogenic disruption of mucocutaneous barriers and intravenous drug use.

Long-Term Carbapenems Antimicrobial Stewardship Program

“…The decrease in the incidence of yeast infection has occurred despite the increase in the number of surgical interventions and the increase of intravascular catheter-associated BSIs, with similar use of parenteral nutrition throughout the study period [ 28 ]. Our results are reinforced by a recent study that shows, on a multivariate analysis, that the treatment of patients with carbapenems was associated with candidemia, adding weight to antimicrobial stewardship efforts and restriction of the use of these broad-spectrum antibiotics [ 15 ].…”

“…In addition to the impact on bacterial resistance, different antimicrobial agents have a different impact on the human gastrointestinal colonization by the Candida species, depending on the pharmacological and antibacterial properties of each drug. It has been demonstrated in the murine model that carbapenems cause high increase of yeast counts in the gastrointestinal tract [ 14 ], and the use of carbapenems in the treatment of hospitalized patients is associated with the development of candidemia [ 15 ].…”

Evaluation of 11 DNA Automated Extraction Protocols for the Detection of the 5 Mains Candida Species from Artificially Spiked Blood

“…Candida species are among the top five pathogens associated with health-care bloodstream infections [ 1 ], carrying a high attributable mortality of up to 40% [ 2 , 3 , 4 ]. Major risk factors for developing candidaemia have well been identified and include critical illness, long-term stay in an intensive care unit, abdominal surgery, malignant haematologic diseases, intravenous catheter, parenteral nutrition, and administration of broad-spectrum antibacterial therapy [ 5 ].…”

Candida spp. Colonization among Intensive Care Unit Patients, Preliminary Results

“…Of these, previous Candida spp. colonization stands out as the main predisposing factor for infection [2]. Colonized patients may also constitute reservoirs of species that are multidrug-resistant to antifungal drugs and that enhance horizontal transmission [2].…”

“…colonization stands out as the main predisposing factor for infection [2]. Colonized patients may also constitute reservoirs of species that are multidrug-resistant to antifungal drugs and that enhance horizontal transmission [2]. The literature on mycological epidemiological data in the intensive care unit (ICU) setting in Portugal is scarce.…”