Top

Published in:

01-12-2003 | Original

Candidemia in critically ill patients: difference of outcome between medical and surgical patients

Authors: Pierre Emmanuel Charles, Jean Marc Doise, Jean Pierre Quenot, Hervé Aube, Frédéric Dalle, Pascal Chavanet, Nadine Milesi, Ludwig Serge Aho, Henri Portier, Bernard Blettery

Published in: Intensive Care Medicine | Issue 12/2003

Abstract

Objective

Candidemia is increasingly encountered in critically ill patients with a high fatality rate. The available data in the critically ill suggest that patients with prior surgery are at a higher risk than others. However, little is known about candidemia in medical settings. The main goal of this study was to compare features of candidemia in critically ill medical and surgical patients.

Design

Ten-year retrospective cohort study (1990–2000).

Setting

Medical and surgical intensive care units (ICUs) of a teaching hospital.

Patients

Fifty-one patients with at least one positive blood culture for Candida species.

Main results

Risk factors were retrieved in all of the patients: central venous catheter (92.1%), mechanical ventilation (72.5%), prior bacterial infection (70.6%), high fungal colonization index (45.6%). Candida albicans accounts for 55% of all candidemia. The overall mortality was 60.8% (85% and 45.2% in medical and surgical patients, respectively). Independent factors associated with survival were prior surgery (hazard ratio [HR] =0.25; 0.09–0.67 95% confidence interval [CI], p<0.05), antifungal treatment (HR =0.11; 0.04–0.30 95% CI, p<0.05) and absence of neutropenia (HR =0.10; 0.02–0.45 95% CI, p<0.05). Steroids, neutropenia and high density of fungal colonization were more frequently found among medical patients compared to surgical ones.

Conclusions

Candidemia occurrence is associated with a high mortality rate among critically ill patients. Differences in underlying conditions could account for the poorer outcome of the medical patients. Screening for fungal colonization could allow identification of such high-risk patients and, in turn, improve outcome.

Available only for authorised users

Beck-Sague C, Jarvis W (1993) Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980–1990. National Nosocomial Infections Surveillance System. J Infect Dis 167:1247–1251PubMedCrossRef

Jarvis W, Martone W (1992) Predominant pathogens in hospital infections. J Antimicrob Chemther 29:19–24CrossRef

Rangel-Frausto M, Wiblin T, Blumberg H, Saiman L, Patterson J, Rinaldi M, Pfaller M, Edwards JJ, Jarvis W, Dawson J, Wenzel R (1999) National epidemiology of mycoses survey (NEMIS): variations in rates of bloodstream infections due to Candida species in seven surgical intensive care units and six neonatal intensive care units. Clin Infect Dis 29:253–258PubMedCrossRef

Vincent J, Bihari D, Suter P, Bruining H, White J, Nicolas-Chanoin M, Wolff M, Spencer R, Hemmer M (1995) The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 274:639–644PubMedCrossRef

Blumberg H, Jarvis W, Soucie J, Edwards J, Patterson J, Pfaller M, Rangel-Frausto M, Rinaldi M, Saiman L, Wiblin R, Wenzel R (2001) Risk factors for candidal bloodstream infections in surgical intensive care unit patients: the NEMIS prospective multicenter study. The National Epidemiology of Mycosis Survey. Clin Infect Dis 33:177–186PubMedCrossRef

Eubanks P, De Virgilio C, Klein S, Bongard F (1993) Candida sepsis in surgical patients. Am J Surg 166:617–620PubMedCrossRef

Nolla-Salas J, Sitges-Serra A, Leon-Gil C, Martinez-Gonzalez J, Leon-Regidor M, Ibanez-Lucia P, Torres-Rodriguez J (1997) Candidemia in non-neutropenic critically ill patients: analysis of prognostic factors and assessment of systemic antifungal therapy. Study Group of Fungal Infection in the ICU. Intensive Care Med 23:23–30PubMedCrossRef

Petri M, Konig J, Moecke H, Gramm H, Barkow H, Kujath P, Dennhart R, Schafer H, Meyer N, Kalmar P, Thulig P, Muller J, Lode H (1997) Epidemiology of invasive mycosis in ICU patients: a prospective multicenter study in 435 non-neutropenic patients. Paul-Ehrlich Society for Chemotherapy, Divisions of Mycology and Pneumonia Research. Intensive Care Med 23:317–325PubMedCrossRef

Soutter D, Todd T (1986) Systemic candidiasis in a surgical intensive care unit. Can J Surg 29:197–199PubMed

10.

Tang E, Tang G, Berne T (1993) Prognostic indicators in fungemia of the surgical patients. Arch Surg 128:759–763PubMedCrossRef

11.

Borzotta A, Beardsley K (1999): Candida infections in critically ill trauma patients. Arch Surg 134:657–665PubMedCrossRef

12.

Pittet D, Monod M, Suter P, Frenk E, Auckenthaler R (1994) Candida colonization and subsequent infections in critically ill surgical patients. Ann Surg 220:751–758PubMedPubMedCentralCrossRef

13.

Voss A, le Noble J, Verduyn Lunel F, Foudraine N, Meis J (1997) Candidemia in intensive care unit patients: risk factors for mortality. Infection 25:8-11PubMedCrossRef

14.

Hadley S, Lee W, Ruthazer R, Nasraway SJ (2002) Candidemia as a cause of septic shock and multiple organ failure in nonimmunocompromised patients. Crit Care Med 30:1808–1814PubMedCrossRef

15.

Komshian S, Uwaydah A, Sobel J, Crane L (1989) Fungemia caused by Candida species and Torulopsis glabrata in the hospitalized patient: frequency, characteristics and evaluation of factors influencing outcome. Rev Infect Dis 11:379–390PubMedCrossRef

16.

Blot S, Vandewoude K, Hoste E, Colardyn F (2002) Effects of nosocomial candidemia on outcomes of critically ill patients. Am J Med 113:480–485PubMedCrossRef

17.

Pelz R, Hendrix C, Swoboda S, Diener-West M, Merz W, Hammonds J, Lipsett P (1999) A double blind placebo controlled trial of prophylactic fluconazole to prevent candida infections in critically ill surgical patients. Crit Care Med 27: A33

18.

Ables A, Blumer N, Valainis G, Godeaick M, Palesh Y (1998) Fluconazole prophylaxis of severe infection in trauma and post-surgical patients. Crit Care Med 26:52ACrossRef

19.

Eggimann P, Francioli P, Bille J, Schneider R, Wu M, Chapuis G, Chiolero R, Pannatier A, Schilling J, Geroulanos S, Glauser M, Calandra T (1999) Fluconazole prophylaxis prevents intra-abdominal candidiasis in high-risk surgical patients. Crit Care Med 27:1066–1072PubMedCrossRef

20.

Garbino J, Lew DP, Romand JA, Hugonnet S, Auckenthaler R, Pittet D (2002) Prevention of severe Candida infections in nonneutropenic, high-risk, critically ill patients: a randomized, double-blind, placebo-controlled trial in patients treated by selective digestive decontamination. Intensive Care Med 28:1708–1717PubMedCrossRef

21.

Le Gall J, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963CrossRef

22.

Bone R (1993) The pathogenesis of sepsis. Ann Intern Med 115:457–469CrossRef

23.

Vincent J, Anaissie E, Bruining H, Demajo W, el-Ebiary M, Haber J, Hiramatsu Y, Nitenberg G, Nystrom P, Pittet D, Rogers T, Sandven P, Sganga G, Schaller M, Solomkin J (1998) Epidemiology, diagnosis and treatment of systemic Candida infection in surgical patients under intensive care. Intensive Care Med 24:206–216PubMedCrossRef

24.

Richet H, Roux P, Des Champs C, Esnault Y, Andremont A, Group FCS (2002) Candidemia in French hospitals: incidence rates and characteristics. Clin Microbiol Infect 8:405–412PubMedCrossRef

25.

Pittet D, Li N, Woolson R, Wenzel R (1997) Microbiological factors influencing the outcome of nosocomial bloodstream infections: a 6-year validated, population-based model. Clin Infect Dis 24:1068–1078PubMedCrossRef

26.

Wey S, Mori M, Pfaller M, Woolson R, Wenzel R (1988) Hospital-acquired candidemia. The attributable mortality and excess length of stay. Arch Intern Med 148:2642–2645PubMedCrossRef

27.

Harvey R, Myers J (1987) Nosocomial fungemia in a large teaching hospital. Arch Intern Med 147:2117–2120PubMedCrossRef

28.

Craven D, Kunches L, Lichtenberg D, Kollisch N, Barry M, Heeren T, McCabe W (1988) Nosocomial infection and fatality in medical and surgical intensive care unit patients. Arch Intern Med 148:1161–1168PubMedCrossRef

29.

Winston D, Chandrasekar P, Lazarus H, Goodman J, Silber J, Horowitz H, Shadduck R, Rosenfeld C, Ho W, Islam M (1993) Fluconazole prophylaxis of fungal infections in patients with acute leukemia. Results of a randomized placebo-controlled, double-blind, multicenter trial. Ann Intern Med 118:495–503PubMedCrossRef

30.

Goodman J, Winston D, Greenfield R, Chandrasekar P, Fox B, Kaizer H, Shadduck R, Shea T, Stiff P, Friedman D (1992) A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation. N Engl J Med 326:845–851PubMedCrossRef

31.

Desai M, Rutan R, Heggers J, Herndon D (1992) Candida infection with and without nystatin prophylaxis. An 11-year experience with patients with burn injury. Arch Surg 127:159–162PubMedCrossRef

32.

Bow E, Laverdiere M, Lussier N, Rotstein C, Cheang M, Ioannou S (2002) Antifungal prophylaxis for severely neutropenic chemotherapy recipients: a meta-analysis of randomized-controlled clinical trials. Cancer 94:3230–3246PubMedCrossRef

33.

Nucci M, Anaissie E (2001) Revisiting the source of candidemia: skin or gut? Clin Infect Dis 33:1959–1967PubMedCrossRef

34.

Rutledge R, Mandel S, Wild R (1986) Candida species. Insignificant contaminant or pathogenic species. Am Surg 52:299–302PubMed

35.

Calandra T, Bille J, Schneider R, Mosimann F, Francioli P (1989) Clinical significance of Candida isolated from peritoneum in surgical patients. Lancet 2:1437–1440PubMedCrossRef

36.

Alverdy J, Aoys E (1991) The effect of glucocorticoid administration on bacterial translocation. Evidence for an acquired mucosal immunodeficient state. Ann Surg 214:719–723PubMedPubMedCentralCrossRef

37.

Tancrede C, Andremont A (1985) Bacterial translocation and gram-negative bacteremia in patients with hematological malignancies. J Infect Dis 152:99–103PubMedCrossRef

38.

Cirera I, Bauer T, Navasa M, Vila J, Grande L, Taura P, Fuster J, Garcia-Valdecasas J, Lacy A, Suarez M, Rimola A, Rodes J (2001) Bacterial translocation of enteric organisms in patients with cirrhosis. J Hepatol 34:32–37PubMedCrossRef

39.

Anaissie E, Rex J, Uzun O, Vartivarian S (1998) Predictors of adverse outcome in cancer patients with candidemia. Am J Med 104:238–245PubMedCrossRef

40.

Slotman G, Shapiro E, Moffa S (1994) Fungal sepsis: multisite colonization versus fungemia. Am Surg 60:107–113PubMed

Title: Candidemia in critically ill patients: difference of outcome between medical and surgical patients
Authors: Pierre Emmanuel Charles
Jean Marc Doise
Jean Pierre Quenot
Hervé Aube
Frédéric Dalle
Pascal Chavanet
Nadine Milesi
Ludwig Serge Aho
Henri Portier
Bernard Blettery
Publication date: 01-12-2003
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 12/2003
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-003-2002-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Candidemia in critically ill patients: difference of outcome between medical and surgical patients

Abstract

Objective

Design

Setting

Patients

Main results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design

Setting

Patients

Main results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2003

Human leukocyte antigen-DR expression in peripheral blood mononuclear cells from healthy donors influenced by the sera of injured patients prone to severe sepsis

Disseminated tuberculosis, pulmonary aspergillosis and cutaneous herpes simplex infection in a patient with infliximab and methotrexate

Searching for evidence: don’t forget the foundations

Do different mattresses affect the quality of cardiopulmonary resuscitation?

End of life care in Canada after a murder charge in an ICU

Lipopolysaccharide-binding protein: a possible diagnostic marker for Gram-negative bacteremia in neutropenic cancer patients