Objectives: Intensive care units (ICU) have emerged as epicentres for fungal infections such as candidaemia. The aim of the study was to investigate candida colonization, colonization index (CI) and its relation to invasive candidiasis in patients with a length of ICU stay (LOS) ≥ 7 days. Material and methods: ICU patients with a LOS ≥ 7 days were consecutively included for sampling during Mars 2004-July 2005. The study was approved by the Ethical Committee in Stockholm. A total of 59 patients, 38 men and 21 women, mean age 59 years (range 19-81) were included. Mean LOS was 19.8 days (range 7-77) and mean days of ventilation was 16 (range 0-74). A majority of the 59 patients were exposed to antimycotic drugs during their ICU stay, 35 received fluconazole, 16 liposomal amphotericin 3 voriconazole and 3 caspofungin. Samples were collected at day 7 and then weekly as long as the patient was admitted to the ICU. Sampling sites were oral cavity, lower airways, urine, blood and rectum from all included patients and from drainage and wounds when this was an option. Results: Fourteen patients were not colonized by candida (CI = 0). C. albicans was isolated from 35 patients, C. glabrata from 10 and 12 had other non-albicans species. Seven patients were colonized by ≥ 2 species of whom two by ≥ 3 species. At the first sampling occasion 42% of the patients (25/59) had a CI ≥ 0.5, eight had CI 1.0, while 26% (8/31) had an index ≥ 0.5 and two had CI 1.0 at day 14. Only 10 patients or fewer were sampled at days 21, 28, 35, 42 and 49, range of mean CI were 0.4-0.7. Ten patients developed invasive candidiasis, of whom six had candidaemia. Mean CI for these 10 patients were 0.8 and all invasive species were also colonizing species. Infections were caused by C. albicans (6), C. glabrata (3), C. tropicalis (1) and C. dubliniensis (1). Nine patients were treated with at least one antimycotic drug, the majority with liposomal amphotericin. The three months mortality among these patients was 70% compared to 49% (29/59) among all included patients. Conclusion: The ICU in the present study is a tertiary unit at a university hospital and 66% of the patients were treated with immunosuppressive drugs (17/59) and/or cortisone (39/59). Despite the fact that all patients were treated with antimycotic drugs as soon as CI exceeded 0.5, invasive candidiasis was diagnosed during the ICU stay in 17% of included patients. A high CI was correlated to invasive candidiasis and high mortality.
Full conference title:
16th European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 16th (2006)