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Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: a multicenter, prospective, observational study in France (2005-2006)
- Source :
- Critical Care Medicine, Critical Care Medicine, Lippincott, Williams & Wilkins, 2009, 37 (5), pp.1612-8. 〈10.1097/CCM.0b013e31819efac0〉, Critical Care Medicine, Lippincott, Williams & Wilkins, 2009, 37 (5), pp.1612-8. ⟨10.1097/CCM.0b013e31819efac0⟩, Critical Care Medicine, 2009, 37 (5), pp.1612-8. ⟨10.1097/CCM.0b013e31819efac0⟩
- Publication Year :
- 2009
- Publisher :
- HAL CCSD, 2009.
-
Abstract
- International audience; OBJECTIVE: To describe the evolving epidemiology, management, and risk factors for death of invasive Candida infections in intensive care units (ICUs). DESIGN: Prospective, observational, national, multicenter study. SETTING: One hundred eighty ICUs in France. PATIENTS: Between October 2005 and May 2006, 300 adult patients with proven invasive Candida infection who received systemic antifungal therapy were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: One hundred seven patients (39.5%) with isolated candidemia, 87 (32.1%) with invasive candidiasis without documented candidemia, and 77 (28.4%) with invasive candidiasis and candidemia were eligible. In 37% of the cases, candidemia occurred within the first 5 days after ICU admission. C. albicans accounted for 57.0% of the isolates, followed by C. glabrata (16.7%), C. parapsilosis (7.5%), C. krusei (5.2%), and C. tropicalis (4.9%). In 17.1% of the isolates, the causative Candida was less susceptible or resistant to fluconazole. Fluconazole was the empirical treatment most commonly introduced (65.7%), followed by caspofungin (18.1%), voriconazole (5.5%), and amphotericin B (3.7%). After identification of the causative species and susceptibility testing results, treatment was modified in 86 patients (31.7%). The case fatality ratio in ICU was 45.9% and did not differ significantly according to the type of episode. Multivariate analysis showed that factors independently associated with death in ICU were type 1 diabetes mellitus (odds ratio [OR] 4.51; 95% confidence interval [CI] 1.72-11.79; p = 0.002), immunosuppression (OR 2.63; 95% CI 1.35-5.11; p = 0.0045), mechanical ventilation (OR 2.54; 95% CI 1.33-4.82; p = 0.0045), and body temperature >38.2 degrees C (reference, 36.5-38.2 degrees C; OR 0.36; 95% CI 0.17-0.77; p = 0.008). CONCLUSIONS: More than two thirds of patients with invasive candidiasis in ICU present with candidemia. Non-albicans Candida species reach almost half of the Candida isolates. Reduced susceptibility to fluconazole is observed in 17.1% of Candida isolates. Mortality of invasive candidiasis in ICU remains high.
- Subjects :
- Male
critically ill
MESH : Aged
MESH : Prospective Studies
Critical Care and Intensive Care Medicine
0302 clinical medicine
Case fatality rate
Hospital Mortality
Prospective Studies
MESH: Incidence
Fungemia
MESH: Treatment Outcome
Cause of death
Aged, 80 and over
Cross Infection
0303 health sciences
MESH: Middle Aged
Incidence
Candidiasis
MESH: Follow-Up Studies
MESH : Incidence
3. Good health
Survival Rate
[SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology
MESH: Young Adult
MESH: Critical Illness
MESH : Intensive Care Units
MESH : Cross Infection
medicine.medical_specialty
MESH: Probability
Critical Illness
MESH : Young Adult
MESH : Cohort Studies
Statistics, Nonparametric
MESH : Hospital Mortality
03 medical and health sciences
MESH: Critical Care
MESH: Fungemia
Intensive care
MESH : Adolescent
Humans
MESH : Middle Aged
MESH: Hospital Mortality
MESH : Aged, 80 and over
Mycosis
Aged
MESH: Adolescent
MESH: Humans
030306 microbiology
MESH : Humans
MESH: Adult
MESH : Follow-Up Studies
MESH: Antifungal Agents
medicine.disease
chemistry
MESH: Female
Fluconazole
Antifungal Agents
MESH : Critical Illness
Cohort Studies
MESH: Cause of Death
chemistry.chemical_compound
MESH : Candidiasis
MESH: Aged, 80 and over
Risk Factors
MESH: Risk Factors
[ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology
Cause of Death
MESH : Female
030212 general & internal medicine
MESH: Cohort Studies
MESH : Critical Care
Candida
intensive care
MESH: Aged
MESH: Statistics, Nonparametric
fungemia
Middle Aged
MESH : Adult
MESH : Survival Rate
MESH : Risk Factors
MESH: Candidiasis
Intensive Care Units
Treatment Outcome
Female
epidemiology
France
medicine.drug
Adult
Adolescent
Critical Care
MESH: Survival Rate
MESH : Male
MESH : Probability
MESH : Antifungal Agents
MESH : Treatment Outcome
Young Adult
Internal medicine
medicine
MESH : France
MESH : Statistics, Nonparametric
Probability
MESH : Cause of Death
Voriconazole
business.industry
MESH: Cross Infection
MESH: Male
MESH: Prospective Studies
Surgery
MESH: France
MESH : Fungemia
MESH: Intensive Care Units
Caspofungin
business
Follow-Up Studies
Subjects
Details
- Language :
- English
- ISSN :
- 00903493 and 15300293
- Database :
- OpenAIRE
- Journal :
- Critical Care Medicine, Critical Care Medicine, Lippincott, Williams & Wilkins, 2009, 37 (5), pp.1612-8. 〈10.1097/CCM.0b013e31819efac0〉, Critical Care Medicine, Lippincott, Williams & Wilkins, 2009, 37 (5), pp.1612-8. ⟨10.1097/CCM.0b013e31819efac0⟩, Critical Care Medicine, 2009, 37 (5), pp.1612-8. ⟨10.1097/CCM.0b013e31819efac0⟩
- Accession number :
- edsair.doi.dedup.....cd65946cb6ea25f53c751d870b5d126d