The Differences in the Epidemiology and Predictors of Death between Candidemia Acquired in Intensive Care Units and Other Hospital Settings

Abstract

Objective The burden of candidemia is shifting from intensive care units (ICU) to non-ICU settings. This study aimed to define the differences in epidemiology and predictors of death between ICU-acquired candidemia (ICUAC) and non-ICUAC. Methods We conducted a retrospective study of 80 patients with ICUAC and 147 patients with non-IUCAC at five hospitals. Results The distribution of Candida species and resistance to antifungal agents did not differ between the ICUAC and non-ICUAC groups. ICUAC patients received more echinocandins and less triazoles, as well as more adequate antifungal therapy than non-ICUAC patients (all p<0.05). ICUAC patients had a significantly higher average acute physiology and chronic health evaluation (APACHE) II score (21.0±7.9 vs. 17.8±8.6; p<0.01), Sequential Organ Failure Assessment score (9.2±5.5 vs. 7.4±3.9; p<0.05) and day-90 mortality rate (52.5% vs. 36.7%; p<0.05) when compared to non-ICUAC patients. Using a multivariate logistic analysis, adequate antifungal therapy was found to be the only protective factor for death in both groups. Respiratory failure supported with invasive mechanical ventilation, renal failure supported with replacement therapy and an APACHE II score ! 20 were independent predictors of death in ICUAC patients, while age ! 60 years, concurrent bacteremia and APACHE II score ! 20 were independent predictors of death in non-ICUAC patients. ConclusionThe Candida species and antifungal resistance profiles in patients with ICUAC were similar to non-ICUAC patients, but led to worse outcomes. The protective and risk factors for death may therefore be relevant for the clinical management of patients with candidemia in ICU and non-ICU settings.

Changes in the distribution of colonising and infecting Candida spp. isolates, antifungal drug consumption and susceptibility in a French intensive care unit: A 10‐year study

“…This difference could be explained not only by the absence in our ICU of patients who had a haematopoietic stem cell or solid organ transplant, but also by the prevention measures implemented since 2005. Candidaemia incidence is higher in ICUs and varies, according to the country, from 2 to 15.1 per 1000 admissions . In our study, it was 4.49 per 1000 admissions.…”

“…As expected, Candida species accounted for most of the fungi iso- Similar data on fungal ecology have been reported by previous studies that assessed the colonisation of patients in ICU. 19,27 Concerning the changes in Candida species involved in candidaemia, 14,23 several studies reported a decrease of C. albicans and an in- 14,20,26,[28][29][30] In our study, it was 4.49 per 1000 admissions. This result is in agreement with two other French studies with a candidaemia incidence ranging from 2 to 6.9 per 1000 admissions.…”

“…albicans was the most frequently encountered species in any situation (colonised patients or with invasive infection), and four species ( C. albicans , C. glabrata , C. parapsilosis and C. tropicalis ) represented more than 86% of the identified fungi. Previous studies reported that C. albicans and C. glabrata are the causative agent of 40% ‐ 66% and 10% ‐ 20%, respectively, of all invasive candidiasis cases in ICU, except in Italy and Portugal, where C. parapsilosis is the second species (8.8% ‐ 22.3% of cases) . As observed by Bassetti et al., C. tropicalis was the third species isolated in sterile site samples (“other sterile sites” in Table ), when not considering blood cultures and catheters.…”

Prognostic factors for candidaemia in intensive care unit patients: a retrospective analysis

“…Our results indicate a relatively high rate when compared with recent studies that reported a rate of 3.06 per 10,000 admissions in an Italian general ward (18) and 15.1 per 10,000 admissions in a Chinese ICU population. (24) This variability in the incidence rates of candidaemia among different countries may be reflective of differences in their healthcare systems, patient backgrounds and/or surveillance methods.…”

Epidemiology of Candida albicans and non-C.albicans of neonatal candidemia at a tertiary care hospital in western China

“…Although several studies had reported the epidemiology of Candida infections in China, they mainly focused on adults, invasive Candida infections or conducted among special groups [14–17]. The investigation about Candida albicans ( C.albicans ) compared to non-C.albicans candidemia in neonatal groups are limited in China [18].…”