Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Annals of Intensive Care
Published in: Annals of Intensive Care 1/2019

Open Access 01-12-2019 | Fluconazole | Research

Candidemia in critically ill immunocompromised patients: report of a retrospective multicenter cohort study

Authors: Etienne Ghrenassia, Djamel Mokart, Julien Mayaux, Alexandre Demoule, Imène Rezine, Lionel Kerhuel, Laure Calvet, Audrey De Jong, Elie Azoulay, Michael Darmon

Published in: Annals of Intensive Care | Issue 1/2019

Login to get access

Abstract

Background

Immunocompromised critically ill patients constitute a population with the high risk of candidemia. This retrospective study aimed to assess the outcome of immunocompromised critically ill patients with candidemia. Secondary objectives were to describe clinical phenotypes of these patients, Candida ecology, and factors associated with mortality.

Results

Overall, 121 patients were included in this study. Median delay from candidemia to first antifungal therapy was 3 days, in line with the observed delay of blood culture positivity. Candia albicans was the main Candida specie identified (54%), and susceptibility of Candida to fluconazole and echinocandins was of, respectively, 70% and 92%. Hospital mortality was of 60%. After adjustment for confounders, severity as assessed by the need for vasopressors (HR 1.8, CI95% 1.1–3.1), need for mechanical ventilation (HR 2.0, CI95% 1.1–3.8) and allogenic stem cell transplantation (HR 2.5, CI95% 1.1–6.0) were independently associated with poor outcome. Candida specie, susceptibility and treatment strategies were not associated with outcome.

Conclusions

Candidemia in immunocompromised critically ill patients is associated with a grim outcome. Despite the high prevalence of Candida non-albicans species, neither C. species nor its susceptibility was associated with outcome. Conversely, severity and preexisting allogeneic stem cell transplantation were independently associated with poor outcome. Despite antifungal prophylaxis and use of preemptive antifungal therapy in neutropenic patients, antifungal therapy was initiated three days after symptoms onset suggesting needs for specific strategies aiming to reduce this delay.
Appendix
Available only for authorised users
Literature
1.
Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis Off Publ Infect Dis Soc Am. 2004;39(3):309–17.CrossRef
2.
Pappas PG, Rex JH, Lee J, Hamill RJ, Larsen RA, Powderly W, et al. A prospective observational study of candidemia: epidemiology, therapy, and influences on mortality in hospitalized adult and pediatric patients. Clin Infect Dis Off Publ Infect Dis Soc Am. 2003;37(5):634–43.CrossRef
3.
Pfaller M, Neofytos D, Diekema D, Azie N, Meier-Kriesche H-U, Quan S-P, et al. Epidemiology and outcomes of candidemia in 3648 patients: data from the Prospective Antifungal Therapy (PATH Alliance®) registry, 2004–2008. Diagn Microbiol Infect Dis. 2012;74(4):323–31.CrossRef
4.
Lortholary O, Renaudat C, Sitbon K, Desnos-Ollivier M, Bretagne S, Dromer F, et al. The risk and clinical outcome of candidemia depending on underlying malignancy. Intensive Care Med. 2017;43(5):652–62.CrossRef
5.
Cornely OA, Gachot B, Akan H, Bassetti M, Uzun O, Kibbler C, et al. Epidemiology and outcome of fungemia in a cancer Cohort of the Infectious Diseases Group (IDG) of the European Organization for Research and Treatment of Cancer (EORTC 65031). Clin Infect Dis Off Publ Infect Dis Soc Am. 2015;61(3):324–31.CrossRef
6.
Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis Off Publ Infect Dis Soc Am. 2016;62(4):e1–50.CrossRef
7.
Kollef M, Micek S, Hampton N, Doherty JA, Kumar A. Septic shock attributed to Candida infection: importance of empiric therapy and source control. Clin Infect Dis Off Publ Infect Dis Soc Am. 2012;54(12):1739–46.CrossRef
8.
Andes DR, Safdar N, Baddley JW, Playford G, Reboli AC, Rex JH, et al. Impact of treatment strategy on outcomes in patients with candidemia and other forms of invasive candidiasis: a patient-level quantitative review of randomized trials. Clin Infect Dis Off Publ Infect Dis Soc Am. 2012;54(8):1110–22.CrossRef
9.
Timsit J-F, Azoulay E, Schwebel C, Charles PE, Cornet M, Souweine B, et al. Empirical micafungin treatment and survival without invasive fungal infection in adults with ICU-acquired sepsis, Candida colonization, and multiple organ failure: the EMPIRICUS randomized clinical trial. JAMA. 2016;316(15):1555–64.CrossRef
10.
Ostrosky-Zeichner L, Shoham S, Vazquez J, Reboli A, Betts R, Barron MA, et al. MSG-01: a randomized, double-blind, placebo-controlled trial of caspofungin prophylaxis followed by preemptive therapy for invasive candidiasis in high-risk adults in the critical care setting. Clin Infect Dis Off Publ Infect Dis Soc Am. 2014;58(9):1219–26.CrossRef
11.
Blumberg HM, Jarvis WR, Soucie JM, Edwards JE, Patterson JE, Pfaller MA, et al. 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 Off Publ Infect Dis Soc Am. 2001;33(2):177–86.CrossRef
12.
Lortholary O, Petrikkos G, Akova M, Arendrup MC, Arikan-Akdagli S, Bassetti M, et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: patients with HIV infection or AIDS. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis. 2012;18(Suppl 7):68–77.
13.
Bassetti M, Peghin M, Carnelutti A, Righi E, Merelli M, Ansaldi F, et al. Invasive Candida infections in liver transplant recipients: clinical features and risk factors for mortality. Transplant Direct. 2017;3(5):e156.CrossRef
14.
Ostrosky-Zeichner L, Pappas PG, Shoham S, Reboli A, Barron MA, Sims C, et al. Improvement of a clinical prediction rule for clinical trials on prophylaxis for invasive candidiasis in the intensive care unit. Mycoses. 2011;54(1):46–51.CrossRef
15.
16.
Azoulay E, Pickkers P, Soares M, Perner A, Rello J, Bauer PR, et al. Acute hypoxemic respiratory failure in immunocompromised patients: the Efraim multinational prospective cohort study. Intensive Care Med. 2017;43(12):1808–19.CrossRef
17.
Gamaletsou MN, Walsh TJ, Zaoutis T, Pagoni M, Kotsopoulou M, Voulgarelis M, et al. A prospective, cohort, multicentre study of candidaemia in hospitalized adult patients with haematological malignancies. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis. 2014;20(1):O50–7.
18.
Slavin MA, Sorrell TC, Marriott D, Thursky KA, Nguyen Q, Ellis DH, et al. Candidaemia in adult cancer patients: risks for fluconazole-resistant isolates and death. J Antimicrob Chemother. 2010;65(5):1042–51.CrossRef
19.
Saillard C, Darmon M, Bisbal M, Sannini A, Chow-Chine L, Faucher M, et al. Critically ill allogenic HSCT patients in the intensive care unit: a systematic review and meta-analysis of prognostic factors of mortality. Bone Marrow Transpl. 2018;53:1233–41.CrossRef
20.
Pène F, Aubron C, Azoulay E, Blot F, Thiéry G, Raynard B, et al. Outcome of critically ill allogeneic hematopoietic stem-cell transplantation recipients: a reappraisal of indications for organ failure supports. J Clin Oncol Off J Am Soc Clin Oncol. 2006;24(4):643–9.CrossRef
21.
Lengliné E, Chevret S, Moreau A-S, Pène F, Blot F, Bourhis J-H, et al. Changes in intensive care for allogeneic hematopoietic stem cell transplant recipients. Bone Marrow Transpl. 2015;50(6):840–5.CrossRef
22.
Lortholary O, Renaudat C, Sitbon K, Madec Y, Denoeud-Ndam L, Wolff M, et al. Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002–2010). Intensive Care Med. 2014;40(9):1303–12.CrossRef
23.
Puig-Asensio M, Padilla B, Garnacho-Montero J, Zaragoza O, Aguado JM, Zaragoza R, et al. Epidemiology and predictive factors for early and late mortality in Candida bloodstream infections: a population-based surveillance in Spain. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis. 2014;20(4):O245–54.
Metadata
Title
Candidemia in critically ill immunocompromised patients: report of a retrospective multicenter cohort study
Authors
Etienne Ghrenassia
Djamel Mokart
Julien Mayaux
Alexandre Demoule
Imène Rezine
Lionel Kerhuel
Laure Calvet
Audrey De Jong
Elie Azoulay
Michael Darmon
Publication date
01-12-2019
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2019
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-019-0539-2

Other articles of this Issue 1/2019

Annals of Intensive Care 1/2019 Go to the issue

Research

The effect of pressure support on imposed work of breathing during paediatric extubation readiness testing

Research

Age-dependent differences in pulmonary host responses in ARDS: a prospective observational cohort study

Editorial

Eliminating endotoxin by polymyxin B hemoperfusion and/or continuous renal replacement therapy: should the focus be on timing, dosing, and type of renal epuration?

Research

Determinants of left ventricular ejection fraction and a novel method to improve its assessment of myocardial contractility

Research

Impact of furosemide on mortality and the requirement for renal replacement therapy in acute kidney injury: a systematic review and meta-analysis of randomised trials

Letter to the Editor

Improve short-term survival in postcardiotomy cardiogenic shock by simultaneous use of intra-aortic balloon pumping with veno-arterial extracorporeal membrane oxygenation: Beware of confounders!