Background: Nosocomial Candida infections are an increasing problem in critically ill patients Methods: A 1-year (2001-2002) prospective multicenter study was conducted in 24 adult ICUs [12 medical ICUs (MICUs), 10 surgical ICUs (SICUs), 1 Burn unit (BU) and 1 Haematology unit (HU)] in Paris, France to investigate the epidemiology, management and outcomes of ICU-acquired candidemia. Case patients were defined as individuals who had at least one positive blood culture for Candida species collected > 48 h after ICU admission. Results are expressed as median and range or percentages. Results: Among 8,509 admissions > 48 h, 57 candidemias (6.7/1,000 admissions; 0.69/1,000 patient-days) occurred 13 days after admission [2-145] in 57 patients. Patients were male (67%), 56 years [15-81], IGS II at admission 43 [18-91]; 11 (19.3%) were neutropenic. Incidence rates were 1.55/1,000 patient-days in BU, 0.86 in HU, 0.69 in SICUs and 0.59 in MICUs. Main species causing candidemia were C. albicans (54%), C. glabrata (17%) and C. parapsilosis (13.5%). Previous colonization with the Candida species responsible for candidemia occurred in 32 (56%) patients. Of 36 patients who had a central venous catheter removal and culturing, 17 (47%) had similar Candida species cultured from blood and catheter. In 46 (81%) patients treated with antifungal agents, fluconazole was used in 36 (78%), and amphotericin B in 24 (52%); duration of antifungal treatment was 14 days [1-55]. One molecule was used in 29 (63%) patients. Eleven (19%) patients have not been treated mainly because of death before microbiological results (n=9). Eighteen (31,6%) patients had documented ICU-acquired candiduria. ICU length of stay in patients was 31 days [3-272]. Crude ICU mortality was 59.6% and 54% in treated patients. Conclusions: Despite of the use of active antifungal agents, ICU-acquired candidemia incidence is high and remains associated with high mortality.
Full conference title:
43rd Interscience Conference on Antimicrobial Agents
- ICAAC 43rd