Risk factors for noncatheter-related Candida bloodstream infections in intensive care units: A multicenter case-control study

Abstract

Candida bloodstream infections are associated with high mortality among critically ill patients in intensive care units (ICUs). Studies that explore the risk factors for candidemia may support better patient care in intensive care units. We conducted a retrospective, multicenter case-control study to investigate the risk factors for noncatheter-related Candida bloodstream infections (CBSI) in adult ICUs. Participants selected controls randomly on a 1:1 basis among all noncase patients stayed during the same period in ICUs. Data on 139 cases and 140 controls were deemed eligible. Among the controls, 69 patients died. The stratified Fine-Gray model was used to estimate the subdistribution Hazard ratios. The subdistribution hazards and 95% confidence intervals for final covariates were as follows: prior exposure to antimycotic agents, 2.21 (1.56–3.14); prior exposure to N-acetylcysteine, 0.11 (0.03–0.34) and prior surgical intervention, 1.26 (0.76–2.11). Of the patients, those exposed to antimycotic drugs, 87.1% (54/62) had breakthrough candidemia. Serious renal, hepatic, or hematologic side effects were comparable between patients those exposed and not-exposed to systemic antimycotic drugs. Untargeted administration of antimycotic drugs did not improve survival among candidemic patients (not-exposed, 63.6% [49/77]; exposed % 66.1 [41/62]; P = .899). This study documented that exposure to an antifungal agent is associated with increased the risk of subsequent development of CBSIs among nonneutropenic adult patients admitted to the ICU. Only two centers regularly prescribed N-acetylcysteine. Due to the limited number of subjects, we interpreted the positive effect of N-acetylcysteine on the absolute risk of CBSIs with caution.

Changing epidemiology and risk factors for candidemia in critically ill patients

“…exceeded C. albicans in another study from the Asia-Pacific region [15]. From different regions of our country, rates of C. albicans in candidemia were reported as 75% by Tukenmez Tigen et al, 72% by Yılmaz Karadag et al, 52.4% by Mermutluoglu et al and 57% by Arslan et al [16][17][18][19]. In compliance with these studies, C. albicans was the overall leading cause of candidemia in our study, but with a decreasing rate from 69.2% to 50% during the study period.…”

Risk Factors for Invasive Candida Infection in Critically Ill Patients

“…A list of the 34 included studies with their characteristics is presented in Table 1 . 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 Of these studies, 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 …”

“…Age 17 , 28 , 34 , 39 , 42 , 47 ( e-Fig 9 ), APACHE II 17 , 39 , 42 , 47 ( e-Fig 14 ), ICU length of stay 46 , 47 ( e-Fig 16 ), colonization index 16 ( e-Fig 70 ), and days of mechanical ventilation and renal replacement therapy 42 ( e-Figs 18 , 21 ) were presented as continuous variables without ORs in several studies. The associations (and lack of associations) of the continuous variables with the risk of ICI were consistent with the findings from the pooled ORs.…”

“…Twenty-nine risk factors were extracted from the selected publications. The results for all risk factors except ICU length of stay (e- Fig 7) are presented in Figure 2 Age 17,28,34,39,42,47 (e- Fig 9), APACHE II 17,39,42,47 (e- Fig 14), ICU length of stay 46,47 with 304 cases with ICI. Therefore, risk factor estimates supported by high-quality studies are limited.…”

Evaluation of the prognostic factors for candidemia in a medical intensive care unit

“…Identifying the risk factors of this infection with high mortality is important to prevent its development, detect patients at risk at its onset and start treatment early [1]. There are many studies on risk factors for candidemia in ICU patients, some of which report different results [3,5,[11][12][13][14]. In these studies, long ICU stay, mechanical ventilation, total parenteral nutrition administration, broad spectrum antibiotic use, presence of diabetes mellitus, immunosuppression, steroid use, central venous catheter interventions, abdominal surgery, hemodialysis, sepsis or septic shock, high SOFA and APACHE II scores, and multiple site Candida isolations have been reported as possible risk factors for candidemia.…”