Candidemia in nonneutropenic critically ill patients: risk factors for non-albicans Candida spp.

Abstract:

OBJECTIVE:The objective of this study was to determine the clinical features associated with candidemia caused by non-albicans Candida spp. and with potentially fluconazole-resistant Candida spp. (C. glabrata and C. krusei) among candidemic intensive care unit patients. DESIGN:The authors conducted a nationwide prospective cohort study. SETTING:The study was conducted in Australian intensive care units. PATIENTS:All patients with intensive care unit-acquired candidemia over a 3-yr period were included in the study. MEASUREMENTS:Clinical risk factors occurring up to 30 days before candidemia, Candida spp. associated with candidemia, and outcomes were determined. Risk factors associated with either non-albicans Candida spp. or with potentially fluconazole-resistant Candida spp. (C. glabrata or C. krusei) were assessed using multivariate logistic regression. MAIN RESULTS:Among 179 episodes of intensive care unit-acquired candidemia, C. albicans accounted for 62%, C. glabrata 18%, C. krusei 4%, and other Candida spp. 16%. Independently significant variables associated with non-albicans Candida bloodstream infection included recent prior gastrointestinal surgery (adjusted odds ratio, 2.87; 95% confidence interval, 1.68-4.91) and recent prior systemic antifungal exposure (4.6; 1.36-15.53). Those associated with potentially fluconazole-resistant candidemia included recent prior gastrointestinal surgery (3.31; 1.79-6.11) and recent prior fluconazole exposure (5.47; 1.23-24.32). No significant differences in outcomes were demonstrated for non-albicans or potentially fluconazole-resistant candidemia. CONCLUSIONS:Among candidemic intensive care unit patients, prior gastrointestinal surgery and systemic antifungal exposure were significantly associated with both a non-albicans Candida spp. and a potentially fluconazole-resistant Candida spp.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Playford EG,Marriott D,Nguyen Q,Chen S,Ellis D,Slavin M,Sorrell TC

doi

10.1097/CCM.0b013e3181760f42

subject

Has Abstract

pub_date

2008-07-01 00:00:00

pages

2034-9

issue

7

eissn

0090-3493

issn

1530-0293

journal_volume

36

pub_type

杂志文章
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    pub_type: 杂志文章,多中心研究,随机对照试验

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    pub_type: 指南,杂志文章,实务指引

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