Candida Bloodstream Infections (BSI) in the Intensive Care Unit (ICU) adult patients

Ref ID: 18779

Author:

M. Puig, MD (Doctor of Medicine) – ID Physician1, J. Garnacho, MD – ID Physician 2, R. Zaragoza, MD – ID Physician 3, J. Pemán, MD – ID Physician 4, M. Valerio, MD – ID Physician 5, E. Martin-Mazuelos, MD – ID Physician 6, B. Almirante, MD – ID Physi

Author address:

1Hosp. Vall d’Hebron, Barcelona, Spain, 2Hosp. Virgen del Rocio, sevilla, Spain, 3Hosp. Universitario Dr. Peset, Valencia, Spain, 4Hosp. La Fe, Valencia, Spain, 5Hosp. gregorio Marañon, Madrid, Spain, 6Hosp. de Valme, Sevilla, Spain.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Objectives: To describe the epidemiology and risk factors for mortality of Candida BSI in the ICU Methods: Prospective population-based surveillance for Candida BSI from May 2010-April 2011 in 5 areas of Spain (population 7,237,228). Case: positive blood culture of Candida spp. We analyzed risk factors for early (3-7 d) and late (8-30 d) mortality rates Results: 752 cases in 729 patients (pts) with Candida BSI were detected. 170 (22.6%) cases in ICU adult pts: 65.3 % men, median age 63 y (range 19-85 y). Underlying conditions: 35.3 renal failure, 24.1% diabetes, 23.5% malignancies, 7.1% transplant recipients. 66.5% cases had prior surgery (35.3% abdominal), 95.3% central venous catheter (CVC) and 62.4% parenteral nutrition. In 55.3% prior Candida colonization. 25.9% receiving antifungal drugs at candidemia onset. Source of candidemia: primary 56.5% cases and secondary 43.5% (34.1% catheter-related, 5.3% abdominal, 2.4% urologic and 1.7% others). C. albicans accounted for (52%), followed by C. parapsilosis (24%), C. glabrata (12%), C. tropicalis (5.7%), C. krusei (4%) and others (2.3%). Decreased susceptibility to fluconazole (MIC≥ 4mg/L) was 13.1%. Echinocandin was the first empirical treatment (52.5%). 79.4% of CVC were removed within 7 d (50% within 48 h). Overall 30 d mortality was 47.6% (17.6% within 7 d). On multivariate analysis, septic shock (OR, 3.4; 95%CI, 1.14 to 10.5) was associated with early death and severity of clinical condition with late mortality: cirrhosis (OR 11.9; 95%CI, 1.06 to 134), requiring hemodyalisis (OR 6.02; 95%CI, 1.48 to 24), mechanical ventilation (OR, 3.8; 95%CI, 1.27 to 11.3) and age >60 y (OR, 3.26; 95%CI, 1.35 to 7.89). Conclusions: Candida BSI in ICU patients is caused by non-albicans species in 48% cases, with 13,1% decreased susceptibility to fluconazole. Overall mortality remains high, related with severity of clinical condition.

Abstract Number: K-950

Conference Poster: y

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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