Prospective Multicenter Surveillance Study of ICU-Acquired Candidemia and Candiduria: the Candiduria Analysis

G. KAC1, M.E. BOUGNOUX, P. AEGERTER, J.Y. FAGON

Author address: 

Hopital Europeen Georges Pompidou, Paris, France, Hopital Ambroise Pare, Boulogne, France

Abstract: 

Background: Nosocomial Candida infections are an increasing problem in critically ill patients. Methods: A one-year (2001-2002) prospective multicenter study was conducted in 24 adult ICUs [12 medical ICUs (MICUs), 10 surgical ICUs (SICUs), one Burn unit (BU) and one Haematology unit (HU)] in Paris, France to investigate the epidemiology, management and outcomes of ICU-acquired candiduria in french hospitals. Case patients were defined as individuals who had at least one positive urine 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, 233 candidurias (27.4 per 1,000 admissions; 2.80 per 1,000 patient-days) occurred 12 days after admission [2-158] in 233 patients. Case patients were female (64%), 68 years [15-101], IGS II at admission 44 [11-115]; 41 (17.6%) had diabetes mellitus, 25 (10.7%) had genito-urinary abnormalities, 24 (10.3%) were neutropenic. Incidence rates were 3.10 per 1,000 patient-days in BU, 2.83 in MICUs, 2.79 in SICUs and 2.57 in HU. Main species causing candiduria were C. albicans (66.5%) and C. glabrata (22%). Of 191 (82%) patients who had a urinary catheter, it was removed in 51 (27%) patients. antifungal therapy was given to 58 (25%) patients, alone (42, 18%) or associated with catheter removal (16, 7%). Fluconazole was used in 47 (85.5% of treated patients), duration of treatment was 10 days [1-54]. No specific therapy for candiduria was given in 140 (60%) patients. Eighteen (7,7%) patients had documented ICU-acquired candidemia. ICU length of stay in case patients was 30 days [2-267]. Crude ICU mortality was 31.3%. Conclusions: ICU-acquired candiduria incidence is high which suggests that urine represents an important reservoir for Candida in ICUs.
2003

abstract No: 

K-452d

Full conference title: 

43rd Interscience Conference on Antimicrobial Agents
    • ICAAC 43rd