Increasing use of antimicrobial therapy in hospital settings associated with introduction of new antifungal agents may induce changes in the incidence of fungal infections and their management. This justifies a prospective surveillance on a periodical basis. To determine the incidence of candidemia and candiduria, epidemiology and management of these infections in critically ill patients, we performed a prospective multicenter study involving 24 adult ICUs in Paris, France. In all, 8,509 patients admitted for more than 48 hours in 9 medical ICUs (MICUs), 9 surgical ICUs (SICUs) and 6 specialised ICUs (SPICUs) (including burn, respiratory and nephrology units) were included between June 1 st 2001 to May 31 st 2002. A total of 57 episodes of candidemia (6.7 per 1,000 admissions) were observed occurring 19••••22 days after admission. Patients with candidemia were male (67%), 56••••18 years, IGS II at admission=47••••18. Incidence rates were not statistically different between MICUs (6.0/1,000), SICUs (6.3/1,000) and SPICUs (8.2/1,000). Main species causing episodes of candidemia were C. albicans (56%), C. glabrata (16%), and C. parapsilosis (14%). When identified (79 %), sources of candidemia were central venous catheter in 18, urine in 19 and digestive tract in 8 patients. Eleven of 57 patients were not treated (death before microbiological results (n=9), discharge (n=1), unknown (n=1)). In 46 treated patients, antifungal agents used were fluconazole in 36 (78%), amphotericin B (AmB) in 24 (52%) (deoxycholate AmB in 14 (30%), lipidic formulation in 10 (22%)), and 5-fluorocytosine in 7 (15%); mean duration of antifungal treatment was 16••••12 days. Mean duration of ICU stay in candidemia patients was 43••••45 days. ICU mortality was 59.6% (n=34). Death was directly attributable to candidemia in 9 (27%), not directly in 12 (35%) and unrelated in 13 (38%). A total of 233 episodes of candiduria (27.4 per 1,000 admissions) were observed. Patients with candiduria were male (34%), 62••••19 years, IGS II at admission=47••••19. Incidence rates were higher in SICUs (32.7/1,000) and in SPICUs (32.4/1,000) than in MICUs (20.6/1,000). Main species responsible for candiduria were C. albicans (70%) and C. glabrata (23%). Mean duration of ICU stay was 38•••• 37 days. ICU mortality was 31% (n=73). Despite of the use of active antifungal agents, ICU-acquired candidemia remains associated with high mortality. Prevention of systemic dissemination in patients with urinary tract, catheter-related or digestive tract colonisation and/or infection should be an area of further investigation.
Full conference title:
The 15 th Congress of the International Society for Human and Animal Mycology
- ISHAM 15th (2003)