1. Invasive Candidiasis in Critically Ill Patients: A Prospective Cohort Study in Two Tertiary Care Centers
- Author
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Pendo Ntinika, Hussam Sakkijha, Tarek Al-Dabbagh, Sameera M. Al Johani, Raymond Khan, Yaseen M. Arabi, Aron Toledo, and Hasan M. Al-Dorzi
- Subjects
Adult ,Male ,medicine.medical_specialty ,Critical Illness ,Critical Care and Intensive Care Medicine ,Tertiary care ,sepsis ,Tertiary Care Centers ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Intensive care ,Epidemiology ,medicine ,Humans ,Candidiasis, Invasive ,Hospital Mortality ,Prospective Studies ,Intensive care medicine ,Critical Care Outcomes ,Prospective cohort study ,Original Research ,intensive care ,Aged ,Candida ,Cross Infection ,business.industry ,Critically ill ,030208 emergency & critical care medicine ,Invasive candidiasis ,Middle Aged ,medicine.disease ,candidiasis ,Intensive Care Units ,Logistic Models ,030228 respiratory system ,antifungal agents ,Female ,critical care outcomes ,business - Abstract
Background: Invasive candidiasis is not uncommon in critically ill patients but has variable epidemiology and outcomes between intensive care units (ICUs). This study evaluated the epidemiology, characteristics, management, and outcomes of patients with invasive candidiasis at 6 ICUs of 2 tertiary care centers. Methods: This was a prospective observational study of all adults admitted to 6 ICUs in 2 different hospitals between August 2012 and May 2016 and diagnosed to have invasive candidiasis by 2 intensivists according to predefined criteria. The epidemiology of isolated Candida and the characteristics, management, and outcomes of affected patients were studied. Multivariable logistic regression analyses were performed to identify the predictors of non-albicans versus albicans infection and hospital mortality. Results: Invasive candidiasis was diagnosed in 162 (age 58.4 ± 18.9 years, 52.2% males, 82.1% medical admissions, and admission Acute Physiology and Chronic Health Evaluation II score 24.1 ± 8.4) patients at a rate of 2.6 cases per 100 ICU admissions. On the diagnosis day, the Candida score was 2.4 ± 0.9 in invasive candidiasis compared with 1.6 ± 0.9 in Candida colonization ( P < .01). The most frequent species were albicans (38.3%), tropicalis (16.7%), glabrata (16%), and parapsilosis (13.6%). In patients with candidemia, antifungal therapy was started on average 1 hour before knowing the culture result (59.6% of therapy initiated after). Resistance to fluconazole, caspofungin, and amphotericin B occurred in 27.9%, 2.9%, and 3.1%, respectively. The hospital mortality was 58.6% with no difference between albicans and non-albicans infections (61.3% and 54.9%, respectively; P = .44). The independent predictors of mortality were renal replacement therapy after invasive candidiasis diagnosis (odds ratio: 5.42; 95% confidence interval: 2.16-13.56) and invasive candidiasis leading/contributing to ICU admission versus occurring during critical illness (odds ratio: 2.87; 95% confidence interval: 1.22-6.74). Conclusions: In critically ill patients with invasive candidiasis, non-albicans was responsible for most cases, and mortality was high (58.6%). Antifungal therapy was initiated after culture results in 60% suggesting low preclinical suspicion. Study registration: NCT01490684; registered in ClinicalTrials.gov on February 11, 2012.
- Published
- 2018
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