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Critical Care
Published in: Critical Care 1/2020

01-12-2020 | Antibiotic | Research

Risk factors for candidemia: a prospective matched case-control study

Authors: Julien Poissy, Lauro Damonti, Anne Bignon, Nina Khanna, Matthias Von Kietzell, Katia Boggian, Dionysios Neofytos, Fanny Vuotto, Valérie Coiteux, Florent Artru, Stephan Zimmerli, Jean-Luc Pagani, Thierry Calandra, Boualem Sendid, Daniel Poulain, Christian van Delden, Frédéric Lamoth, Oscar Marchetti, Pierre-Yves Bochud, the FUNGINOS, Allfun French Study Groups

Published in: Critical Care | Issue 1/2020

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Abstract

Background

Candidemia is an opportunistic infection associated with high morbidity and mortality in patients hospitalized both inside and outside intensive care units (ICUs). Identification of patients at risk is crucial to ensure prompt antifungal therapy. We sought to assess risk factors for candidemia and death, both outside and inside ICUs.

Methods

This prospective multicenter matched case-control study involved six teaching hospitals in Switzerland and France. Cases were defined by positive blood cultures for Candida sp. Controls were matched to cases using the following criteria: age, hospitalization ward, hospitalization duration, and, when applicable, type of surgery. One to three controls were enrolled by case. Risk factors were analyzed by univariate and multivariate conditional regression models, as a basis for a new scoring system to predict candidemia.

Results

One hundred ninety-two candidemic patients and 411 matched controls were included. Forty-four percent of included patients were hospitalized in ICUs, and 56% were hospitalized outside ICUs. Independent risk factors for candidemia in the ICU population included total parenteral nutrition, acute kidney injury, heart disease, prior septic shock, and exposure to aminoglycoside antibiotics. Independent risk factors for candidemia in the non-ICU population included central venous catheter, total parenteral nutrition, and exposure to glycopeptides and nitroimidazoles. The accuracy of the scores based on these risk factors is better in the ICU than in the non-ICU population. Independent risk factors for death in candidemic patients included septic shock, acute kidney injury, and the number of antibiotics to which patients were exposed before candidemia.

Discussion

While this study shows a role for known and novel risk factors for candidemia, it specifically highlights important differences in their distribution according to the hospital setting (ICU versus non-ICU).

Conclusion

This study provides novel risk scores for candidemia accounting for the hospital setting and recent progress in patients’ management strategies and fungal epidemiology.
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Metadata
Title
Risk factors for candidemia: a prospective matched case-control study
Authors
Julien Poissy
Lauro Damonti
Anne Bignon
Nina Khanna
Matthias Von Kietzell
Katia Boggian
Dionysios Neofytos
Fanny Vuotto
Valérie Coiteux
Florent Artru
Stephan Zimmerli
Jean-Luc Pagani
Thierry Calandra
Boualem Sendid
Daniel Poulain
Christian van Delden
Frédéric Lamoth
Oscar Marchetti
Pierre-Yves Bochud
the FUNGINOS
Allfun French Study Groups
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2020
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-020-2766-1

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