Risk factors for candidal bloodstream infections in surgical intensive care unit patients: the NEMIS prospective multicenter study. The National Epidemiology of Mycosis Survey.
To assess risk factors for development of candidal blood stream infections (CBSIs), a prospective cohort study was performed at 6 sites that involved all patients admitted to the surgical intensive care unit (SICU) for >48 h over a 2-year period. Among 4276 such patients, 42 CBSIs occurred (9.82 CBSIs per 1000 admissions). The overall incidence was 0.98 CBSIs per 1000 patient days and 1.42 per 1000 SICU days with a central venous catheter in place. In multivariate analysis, factors independently associated with increased risk of CBSI included prior surgery (relative risk [RR], 7.3), acute renal failure (RR, 4.2), receipt of parenteral nutrition (RR, 3.6), and, for patients who had undergone surgery, presence of a triple lumen catheter (RR, 5.4). Receipt of an antifungal agent was associated with decreased risk (RR, 0.3). Prospective clinical studies are needed to identify which antifungal agents are most protective and which high-risk patients will benefit from antifungal prophylaxis.
Blumberg
H M
HM
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicinel, Atlanta, GA 30303, USA. hblumbe@emory.edu
Jarvis
W R
WR
Soucie
J M
JM
Edwards
J E
JE
Patterson
J E
JE
Pfaller
M A
MA
Rangel-Frausto
M S
MS
Rinaldi
M G
MG
Saiman
L
L
Wiblin
R T
RT
Wenzel
R P
RP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D002175:Candida / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D002177:Candidiasis / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D016469:Fungemia / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D009894:Opportunistic Infections / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D000935:Antifungal Agents