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Risk factors and outcome of critical ill patients with candidaemia

Abstract number: 1733_779

Pratikaki M., Platsouka E., Routsi C., Sotiropoulou C., Priovolos A., Angelopoulos E., Paniara O., Roussos C.

Objective: To determine the incidence and risk factors of Candida bloodstream infection in non-neutropenic critically ill patients and to define whether nosocomial candidaemia is associated with increased mortality in intensive care unit (ICU) patients.

Methods: This is a retrospective cohort study, conducted in the 30-bed multidisciplinary ICU of Evangelismos Hospital in Athens, during a 18-month period (August 2004–January 2006). All patients with ICU stay more than 48 hours were included. Patients with microbiologically documented candidaemia were matched to control patients (1:4). Matching was based on an equivalent APACHE II score (±2 points), diagnostic category, and length of ICU stay (±2 days).

Results: During the study period, 33 of 855 consecutively admitted patients developed one or more episodes of candidaemia, giving an incidence of 3.86 per 100 patients. Candida albicans was identified in 11 patients (33.3%) and Candida non-albicans species in 22 patients (66.7%). Population characteristics, included age, gender, underlying disease, hospitalisation before ICU admission, length of ICU stay and in-hospital mortality rates of patients with candidaemia and their controls were compared. We used APACHE II score on ICU admission to compute the total estimated risk of death for all patients; this was 23% (12.15–50.5), median value. Mortality rates for cases and controls were 60.6% and 22.0% respectively, giving an attributable mortality of 38.6%. The best independent prognostic factor for the development of candidaemia was the presence of ARDS (OR, 3.995; 95% CI 1.332–11.983, p = 0.013). By multivariate analysis, independent predictors of mortality for cases and their controls were: admission APACHE II score (OR, 1.168; 95% CI 1.105–1.236, p < 0.001), and the presence of candidaemia (OR, 9.374; 95% CI 3.479–25.259, p < 0.001). Also multivariate analysis, showed that independent predictors of mortality for candidemic patients, were: SOFA score (OR, 1.568; 95% CI 1.000–2.457, p = 0.05), and hypoalbuminaemia (OR, 0.049; 95% CI 0.005–0.515, p = 0.012), both on candidaemia day.

Conclusion: The incidence of bloodstream infections caused by yeasts was 3.86% in our ICU. There was a predominance of Candida species other than Candida albicans, and candidaemia was associated with an excess mortality rate.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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