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Invasive candidiasis, Candida colonisation and antifungal treatment in intensive care patients after cardiothoracic surgery

Abstract number: P1799

Kratzer C., Tobudic S., Graninger W., Lassnigg A., Vorderwinkler A., Fischer H., Presterl E.

Objectives: To improve the diagnosis, the timing of diagnostic procedures and antifungal treatment of invasive Candida infections in intensive care patients, a prospective surveillance study was performed at our cardiothoracic intensive care unit (ICU) of the Medical University of Vienna.

Methods: Patients admitted to the cardiothoracic ICU between December 2006 and November 2007 were enrolled into the study. Two times weekly surveillance cultures (n = 2413) of inguinal swabs (17%), axillary swabs (17%), pharyngeal swabs (17%), urine (14%), nasal swabs (13%), bronchial lavage (11%), surgical wounds (4%) and anal swabs (2%) were taken. At each time point material from at least five different body sites was analysed for presence of Candida. The Candida Colonization Index (CI) was calculated for each patient by the number of Candida positive samples per all samples. Patients were grouped as follows: no colonisation (CI leqslant R: less-than-or-eq, slant 0.2; n = 19), colonisation (CI > 0.2 < 0.6; n = 30) and severe colonisation (CI geqslant R: gt-or-equal, slanted0.6; n = 36). As risk factors time of stay on the ICU, number and type of surgeries, sex and age of patients and start of antifungal treatment were investigated.

Results: A total of 85 patients were enrolled into the study, the overall mortality was 39.2%. The different types of surgeries included valve replacement, aortocoronary bypass, heart or lung transplantation, implantation of left ventricular assist device or artificial heart with a mean of 2.1 surgeries per patient. During the first four weeks on ICU Candida albicans was the predominating pathogen (39 to 49% of all cultures). The percentage of Non-albicans species, particularly Candida parapsilosis and Candida glabrata increased over time. Sex, age of patients, the type of surgery and the start of antifungal treatment were no significant risk factors for severe colonisation. A significant difference between colonised and severly colonised patients was detected for the time of stay on ICU (median= 23 days versus 48 days; p < 0.001) and the number of surgeries (median= 1.7 versus 2.7; p = 0.02). All patients who developed Candidaemia (n = 4) were previously severly colonised with Candida. The mortality rate in multifocal colonised patients was 50%.

Conclusion: Prolonged stay on ICU and number of surgical interventions >2 predicted for severe colonisation in patients at a cardiothoracic ICU. Candidaemia was exclusively detected in patients who were previously severly colonised with Candida.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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