ECMM survey of risk factors and practice in the management of invasive yeast infections in European surgical Intensive Care units

Longley1, N.G., Barnes2, R., Klingspor3, L., Kibbler1, C., Meis4, J., Ruhnke5, M., Tortorano6, A., Velegraki7, A., Peman8, J., Nagy9, E., Willinger10, B., Kaczur11, A.

Author address: 

1 Royal Free Hampstead NHS Trust, LONDON, United Kingdom 2Cardiff University College of Medicine, CARDIFF, United Kingdom 3Division of Clinical Bacteriology, Kardi, STOKHOLM, Sweden 4Canisius Wilhelmina Hospital, NIJMEGEN, The Netherlands 5Ch


Background: Invasive candidal infection is a potentially life-threatening complication of intensive care stay affecting up to 10% of patients admitted to the units where it can represent up to 15% of nosocomial infections. Invasive candidal infection is on the rise. This is due to the increase in ICU beds, widespread use of broad-spectrum antibiotics, organ transplantation and the increased use of immunosuppressive agents. This survey has been conducted in order to collect background data for a forth-coming epidemiological study of invasive yeast infections in European surgical ICU patients. We have collected data from representative European ICUs to provide basic epidemiological data, to determine the use of the different diagnostic procedures and to try to examine the use of prophylaxis and empirical therapy in these different units. Methods: A questionnaire was sent out to the national coordinators of the ECMM ICU invasive yeast epidemiological survey. They disseminated the survey to ICU clinicians and their corresponding mycologists at selected study sites in 17 European countries. The questionnaire asked the clinicians for epidemiological data and their current practice with respect to ICU infection management looking specifically at antibiotic use, antifungal prophylaxis, central line use/removal and numbers of high-risk patient groups. The corresponding mycologist was questioned on candida surveillance, culture techniques and the use of candida serology and molecular diagnostic techniques. Results: 46 completed questionnaires were received from 10 different countries. 7 countries did not reply. The sites reported a wide variation in both the annual number of surgical ICU admissions (median 400, range 40-2600), the types of patients admitted to their units and the estimated annual number of invasive candidal infections (median 3.5, range 4-60). Of the 46 sites that participated, 18 routinely used prophylactic antifungals and 42 sites routinely gave antibiotic prophylaxis prior to surgery, with the course varying from 1 dose to 8 days. A wide range of broad- spectrum antibiotics was used as first line treatment for post surgical sepsis. Empirical antifungal treatment was used in 26 sites. The central line was routinely removed after the diagnosis of candidaemia in 36 of the sites. However, at 3 sites lines were apparently only removed 25% of the time. Routine Candida surveillance was carried out in 23 of the sites, the frequency varying from every two days to weekly. Nine of the 46 centres routinely used serological testing for invasive candidal infection and 12 of the sites used molecular methods. Conclusions: This preliminary questionnaire has given us valuable data on anti- infective practices and risk factors for fungal infection in European surgical ICUs. It has exposed a wide variation in the use of antimicrobials and diagnostic approaches, which may explain the variation in the incidence of candidaemia seen in the literature. It will help us interpret the more detailed survey, which is now being carried out prospectively at these sites over a two-year period.

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Full conference title: 

3rd Trends in Medical Mycology
    • TIMM 3rd (2011)